Effect of preoperative exercise on vascular caliber and maturation of arteriovenous fistula: the physicalfav trial, a randomized controlled study

Sauco, Inés Aragoncillo; Hevia, C; León, Andrés García; Amézquita, Yésika; Macías, Nicolás; Caldés, Silvia; Senent, B. Ramírez; Hernández, Yolanda; Goicoechea, Marián

doi:10.1007/s40620-020-00907-w

Cited by 10 publications

(12 citation statements)

References 30 publications

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“…These results are similar to those findings observed in other studies evaluating PIE in vascular access. [13][14][15] A smaller caliber increase, was observed regarding traditional risk factors of lack of maturation: older age, female gender, and diabetes. 17 Thus, an AVFn could be performed in most of the patients included: a radiocephalic fistula was created in 91.3% of patients of NRC-AVF group and an AVFn could be created in 72.7% of patients of NA-AVF group (even a radiocephalic fistula was performed in 43.7% of them).…”

Section: Discussionmentioning

confidence: 93%

“…Compliance with exercise was assessed through a questionnaire validated for a clinical trial. 13 Patients continue performing PIE handgrip exercise while they were included on waiting list. They were followed after surgery, primary failure rate, AVFn maturation and vascular access functionality in hemodialysis were collected.…”

Section: Methodsmentioning

confidence: 99%

“…[2][3][4][5] Furthermore, preoperative isometric exercise (PIE) is also recommended in some VA guidelines. [2][3][4] The benefit of preoperative exercise has been analyzed in three recent randomized controlled trials, [13][14][15] that found an improvement in vessels caliber and the largest one even the possibility to perform greater number of radiocephalic AVFn. 13 However it is unknown whether PIE might enhance the performance of AVFn in patients who are not initially candidates.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] The benefit of preoperative exercise has been analyzed in three recent randomized controlled trials, [13][14][15] that found an improvement in vessels caliber and the largest one even the possibility to perform greater number of radiocephalic AVFn. 13 However it is unknown whether PIE might enhance the performance of AVFn in patients who are not initially candidates. There is only one small observational study which evaluated PIE in 15 patients not initially candidates for AVF, achieving an autologous fistula in 5 of 15 patients after 8 weeks of exercise.…”

Section: Introductionmentioning

confidence: 99%

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Impact of preoperative exercise in not initially candidates to native arteriovenous fistulas

et al. 2021

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Background: Native autologous arteriovenous fistula (AVFn) is the preferred vascular access for hemodialysis due to its long term patency and low complication rate. A challenging limitation is the anatomical inability to perform AVFn and failure of maturation. Preoperative isometric exercise (PIE) can increase vascular calibers and improve the rate of distal AVF. However, it is unknown whether PIE might enhance the performance of AVFn in patients who are not initially candidates. Methods: A retrospective observational study was conducted over a population of 45 patients evaluated in vascular access clinic, 23 were not initially candidates for radiocephalic (NRC-AVF) and 22 were not candidates for autologous fistula at all (NA-AVF). They were assigned to perform PIE with handgrip device and revaluated. Results: After 4–8 weeks of PIE, a AVFn was performed in 16 patients from NA-AVF group and a radiocephalic AVFn was performed in 21 patients from NRC-AVF group. Both groups experienced a significant and similar increase in venous caliber 0.91 ± 0.43 mm in NA-AVF versus 0.76 ± 0.47 mm in NRC-AVF ( p = 0.336) and arterial caliber 0.18 ± 0.24 mm versus 0.18 ± 0.21 mm ( p = 0.928), respectively. Nevertheless, primary failure rate was significantly higher in NA-AVF ( n = 8, 50%) than in NRC-AVF group ( n = 3, 14.3%) ( p = 0.030). After 6 months, the fistula usability for dialysis was only 50% in NA-AVF, while 86.7% were dialyzed by fistula in NRC-AVF group ( p = 0.038). Conclusions: PIE allowed the allocation of an AVFn in patients not initially candidates, but entailed a high rate of maturation failure. Patients not candidates to radiocephalic AVF benefited from PIE and preserved a long term usability of AVF for dialysis.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of preoperative exercise in not initially candidates to native arteriovenous fistulas

et al. 2021

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“…5 Ongoing randomized clinical trials 6,7 are evaluating benefits of preoperative isometric exercise in patients requiring an AVF. The PhysicalFAV, 8 which was carried out by our working group, showed a significant improvement in vascular calibers as well as in the rate of distal arteriovenous fistulas performed. During patient recruitment, we also offered isometric exercise to those who did not fulfill inclusion criteria, including the adolescents.…”

Section: Introductionmentioning

confidence: 82%

Impact of Isometric Exercise in Adolescents With End Stage Kidney Disease and Unsuitable Vessels For An Autologous Arteriovenous Fistula

Ramírez-Senent

Aragoncillo

Ligero

2022

Vasc Endovascular Surg

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Introduction Despite the lack of calcification, to perform a native Arteriovenous Fistula (AVF) in young patients may pose a challenge due to small vessel diameter. We report a case series with no options of AVF in which vessel caliber improvement after isometric exercise allowed for radiocephalic fistula creation in all of them. Methods Since 2017 to 2019, four patients were referred to our unit to create an AVF. Following a first assessment with physical examination and doppler ultrasound, none of them were eligible for AVF performance due to small vessel caliber. Once they were considered unsuitable for it, they started an isometric exercise program. Results Age ranged from 13 to 19 years. There were three males and one female. Two were in predialysis and two in hemodialysis program. Initial diameters of the forearm cephalic vein and the radial artery respectively were: case A < 1.5/2.3 mm, case B 1.5/1.6 mm, case C < 1.5/1.6 mm and case D 2.1/1.3 mm. Median duration of exercise program was 13 weeks (range 5-23). Post-exercise vessel diameters were: case A 2.7/2.3 mm, case B 2.5/2 mm, case C 2.8/1.8 mm and case D 2.7/2 mm. Radiocephalic AVF were performed in the four cases. After a median follow up of 19 months (range 9-30 months), 75% of patients required further interventions but all of them had a functional AVF. Conclusions In these four cases isometric preoperative exercise allowed the creation of AVF. Without the improvement in vessel diameter observed afterwards, all of them would have been rejected for AVF performance. Despite the high rate of adjunctive interventions needed, given the safety of the program and the potential risks of Central Venous Catheters, we consider it a valuable option.

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Upper limb exercise for arteriovenous fistula maturation in people requiring permanent haemodialysis access

Nantakool

Reanpang

Prasannarong

et al. 2022

Cochrane Database of Systematic Reviews

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Effect of preoperative exercise on vascular caliber and maturation of arteriovenous fistula: the physicalfav trial, a randomized controlled study

Cited by 10 publications

References 30 publications

Impact of preoperative exercise in not initially candidates to native arteriovenous fistulas

Impact of preoperative exercise in not initially candidates to native arteriovenous fistulas

Impact of Isometric Exercise in Adolescents With End Stage Kidney Disease and Unsuitable Vessels For An Autologous Arteriovenous Fistula

Upper limb exercise for arteriovenous fistula maturation in people requiring permanent haemodialysis access

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