Vascular access Localization Determines Regional Changes in Arterial Stiffness

Abstract

Background Vascular access (VA) dysfunction is a common cause of hospitalization in chronically hemodialyzed patients (CHP) limiting the improvement in health and has been largely studied in order to decrease the morbidity events that involves both the artery and the vein used in the construction of the fistula. In parallel, patients in end-stage renal failure show an increase in arterial stiffness. Aim The aims of this work were: (a) to evaluate arterial stiffness through pulse wave velocity (PWV) measurements in the carotid-brachial pathway where the arteriovenous fistulae (AVF) was constructed, and (b) to determine possible differences in arterial stiffness between the carotid-brachial pathway with and without VA. Methods PWV, clinical and biochemical parameters were measured in 38 CHP. PWV was obtained in the carotid-femoral, and in the left and right carotid-brachial pathway. Results Carotid-brachial PWV determination in upper limbs with AVF (10.07 ± 2.43 m/s) showed significantly lower values than those observed in the contra-lateral arm without VA (11.55 ± 2.27 m/s). Curiously, the PWV value observed in arms with an AVF was significantly lower in diabetic than in non-diabetic hemodialyzed patients (NDHP) (8.00 ± 2.86 m/s and 10.38 ± 2.33 m/s; respectively). Measurements of PWV in the carotid-femoral pathway in CHP showed a mean value of 14.09 ± 3.12 m/s. Carotid-femoral PWV in NDHP (14.06 ± 2.44 m/s) was significantly lower than that observed in the diabetic patients (16.87 ± 3.42 m/s). Conclusions Carotid-brachial PWV values obtained in the upper limbs, in which VAs were constructed, were significantly lower than that measured in intact arteries in the contra-lateral pathway in CHP.

Arterial Stiffness in a Rural Population of Argentina: Pilot Study

“…It has also been determined that the elasticity of the arterial wall is sensitive to changes such as those occurring in patients undergoing hemodialysis [21]. Recent studies of Calculated from odds ratio (OR) and multinomial logistic regression LL lower limit, UL upper limit, FHCvD familiar history of CV disease arterial elasticity of large vessels have shown differences between gender and ethnic groups [13,14].…”

“…Briefly, we studied 21 subjects in which PWV was randomly measured on the same acquisition session through both, blood flow waves with Doppler technique [23] (Esaote My Lab 40, using a 7 MHz probe) and the Arteriometer technique (Arteriometer V100, Oxytech, Buenos Aires, Argentina) using tonometry to record the arterial pulse wave profile as previously reported [21,22]. Shortly, two high fidelity strain gauge mechano-transducers (Motorola MPX 2050, Motorola Inc., Schaumburg, Il, USA) were positioned over the carotid and femoral arteries to obtain the blood pressure waves profiles.…”

“…The validation analysis was performed as requested by the Artery Society Guidelines [20]. Data acquisition and pulse wave velocity calculation were performed using hardware and software previously reported (Arteriometer V100, Oxytech, Buenos Aires, Argentina) [21,22] to compare the data obtained with the mentioned technology against those calculated through blood flow waves (Echo-Doppler).…”

“…Measurement: Pulse wave velocity was obtained according to the technique previously published and developed in Favaloro University [21,22]. Briefly, two high-fidelity silicon piezo-resistive pressure sensors (Motorola MPX 2050, Motorola Inc., Corporate 1303 E. Algonquin Road, Schaumburg, Illinois 60196, USA) were connected to an amplifier during data acquisition.…”

Hemodialysis Decreases the Etiologically-Related Early Vascular Aging Observed in End-Stage Renal Disease: A 5-Year Follow-Up Study

“…To this end, carotid and femoral artery waveforms were recorded using high-fidelity mechano-transducers simultaneously placed on the skin over the carotid and femoral arteries, keeping the patients in the supine position (Arteriometer, Model V100, Oxytech, Buenos Aires, Argentina) [18,[22][23][24] ( fig. 1 ).…”