Access Flow Reduction for Cardiac Failure

Bourquelot, P

doi:10.5301/jva.5000517

Cited by 14 publications

(13 citation statements)

References 15 publications

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“…Congruently, patients with AV fistula closure show a decrease in both eccentric and concentric hypertrophy . Banding and revision to reduce AV fistula blood flow can improve cardiac structure and hemodynamics …”

Section: Hd‐induced Stress and Injurymentioning

confidence: 99%

Hemodialysis‐induced cardiovascular disease

Ahmadmehrabi

Tang

2018

Seminars in Dialysis

129

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More than half of all deaths among end stage renal disease (ESRD) patients are due to cardiovascular disease (CVD). Cardiovascular changes secondary to renal dysfunction, including fluid overload, uremic cardiomyopathy, secondary hyperparathyroidism, anemia, altered lipid metabolism, and accumulation of gut microbiota-derived uremic toxins like trimethylamine N-oxidase, contribute to the high risk for CVD in the ESRD population. In addition, conventional hemodialysis (HD) itself poses myocardial stress and injury on the already compromised cardiovascular system in uremic patients. This review will provide an overview of cardiovascular changes in chronic kidney disease and ESRD, a description of reported mechanisms for HD-induced myocardial injury, comparison of HD with other treatment modalities in the context of CVD, and possible management strategies.

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Section: Hd‐induced Stress and Injurymentioning

confidence: 99%

Hemodialysis‐induced cardiovascular disease

Ahmadmehrabi

Tang

2018

Seminars in Dialysis

129

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“…for poor immediate-or long-term results (6,7). Other investigators have reported excellent outcomes with adherence to precise restriction techniques, often guided by intraoperative ultrasound flow measurements (3)(4)(5).…”

Section: Case Reportmentioning

confidence: 99%

A mechanism of banding failure in excessively dilated fistulas

2018

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Identical findings in these four patients suggest that the extensive infolding and caliber diameter reduction created by banding these massively dilated fistulas, when combined with the pulsatility induced in the pre-banding segment, leads to a gradual incorporation of the suture tie into the vessel wall and finally within the lumen. We suggest erosion of banding material and failure of flow reduction may occur with any technique but may be more likely with a single polypropylene suture restricting very large AVF. We suggest such excessively dilated fistulas requiring flow reduction may be successfully treated by reconstruction of the AVF anastomosis to a much smaller size with tapering of the outflow vein to accommodate the revision.

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“…9 In the literature, there are rather few studies about echocardiographic modifications after AVF flow reduction in HD patients. [10][11][12] Proximal Radial Artery Ligation (PRAL), as described by Bourquelot and colleagues, 13,14 is an effective minimally invasive technique for distal radio-cephalic (RC) AVF flow reduction. Aim of this study was to evaluate prospectively early echocardiographic modifications occurring after PRAL in a population of consecutive HD and transplant patients with high-flow AVF associated CHF.…”

Section: Introductionmentioning

confidence: 99%

Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

Maresca¹,

Filice

Orlando

et al. 2020

J Vasc Access

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Background: Arteriovenous fistula (AVF) for haemodialysis (HD) induces a volume/pressure overload which impairs bi-ventricular function and increases systolic pulmonary arterial pressure (PAPS) and left ventricular mass (LVM). In the presence of high blood flow (Qa) AVF (> 1.5 L/min/1.73 m2) and cardio-pulmonary recirculation (>20%), high-output congestive heart failure (CHF) may occur and AVF flow reduction is recommended. Proximal Radial Artery Ligation (PRAL) is an effective technique for distal radio-cephalic (RC) AVF flow reduction. Methods: we evaluated six HD and four transplant patients with high-flow RC AVF and symptoms of CHF who underwent PRAL. We compared echocardiographic (ECHO) findings before (T0) and 1 and 6 months (T1,T6) after PRAL. Preoperative ECHO was performed before (T0b) and after AVF anastomosis manual compression (T0c). Results: At T1 AVF flow reduction rate was 58.4% ± 13% and 80% of patients reported improved CHF symptoms. ECHO data showed an improvement of tricuspid annular plane systolic excursion (TAPSE) at T1 (p = 0.03) and a reduction of PAPS at T6 (p = 0.04). TAPSE improved after AVF anastomosis compression during preoperative ECHO (p = 0.03). Delta of TAPSE at the dynamic manoeuvre at T0 directly correlated with early (1 month after PRAL, p = 0.01) and late (6 months after PRAL, p = 0.04) deltas of TAPSE. Conclusions: AVF flow reduction after PRAL induces immediate regression of CHF symptoms, early improvement of TAPSE and late improvement of PAPS, suggesting a prevalent right sections involvement in CHF. Preoperative TAPSE modification after AVF anastomosis compression could represent a useful evaluation tool to determine which patients would benefit of PRAL.

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Access Flow Reduction for Cardiac Failure

Cited by 14 publications

References 15 publications

Hemodialysis‐induced cardiovascular disease

Hemodialysis‐induced cardiovascular disease

A mechanism of banding failure in excessively dilated fistulas

Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

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