Fistula Size and Hemodynamics: An Experimental Model in Canine Femoral Arteriovenous Fistulas

Ramacciotti, Eduardo; Galego, Sidnei José; Gomes, Marise; Goldenberg, Saul; Gomes, Paulo de Oliveira; Ortiz, Jayme Pinto

doi:10.1177/112972980700800107

Cited by 13 publications

(16 citation statements)

References 9 publications

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“…We found that vessel diameters increased at shunt side; the arterial and venous parts were sized near similar to each other. Histologically increased number of smooth muscle elements and significant amount of connective tissue, intimal hyperplasia were seen, as it was expected according to the literature data 8, 10, 12, 14…”

Section: Discussionsupporting

confidence: 82%

“…Physiology, maturation (four to six weeks), arterialization and neointima formation of artificial AV fistulas have been widely studied 8, 10, 12, 14, 31, 32. Intimal hyperplasia seems to occur in specific locations at the anastomotic vessels, and this process is determined by hemodynamic factors, and in turn, these may influence local flow characteristics, too 16, 17.…”

Section: Discussionmentioning

confidence: 99%

“…For studying AV anastomoses numerous animal models are known for mouse,8 rat,9 dog,10 sheep,11 and pig 12, 13. These models provide possibilities to examine clinically important questions on shunt size and geometry, flow characteristics, morphological changes in vessel wall and the impact of various metabolic and vascular diseases on shunt patency 3, 14–16.…”

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confidence: 99%

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Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Hever¹,

Németh

Bráth³

et al. 2010

Microsurgery

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Artificial femoral arterio-venous (AV) shunts are widely used in rodent models for studying shunt maturation and to optimize various surgical techniques. However, little is known about complex circulatory, microcirculatory, and hemorheological effects of end-to-side saphenous AV shunts. We aimed to study these parameters in mature AV shunts. Studying these questions in CD rats, end-to-side anastomoses were made between the left saphenous artery and vein. On the right-side the nonoperated saphenous vessels served as own control. Furthermore healthy control animals were also investigated. On the 8th to 12th postoperative week microcirculatory and blood flow measurements were performed and blood samples were taken both from the shunt's arterial and venous limbs and from the nonoperated side vessels. Hematological parameters, erythrocyte aggregation, and deformability were determined. The entire shunt and the control vessels were removed for histological examinations. The skin microcirculation on shunt side slightly increased on thigh and decreased on paws versus the nonoperated side. Blood flow measurements made directly on the vessels showed that arterial to venous blood flow rate ratio was 1.59 ± 0.29 on nonoperated side and 1.2 ± 0.13 on the shunt side, and 1.49 ± 0.05 in control animals. Erythrocyte aggregation and deformability worsened on the shunt side. Histologically increased number of smooth muscle elements and connective tissue were found in venous limb of the shunts. The artificial AV shunt between the saphenous artery and vein seems to be a suitable model for further functional-morphological and hemorheological examinations of hemodialysis in various states and diseases.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Hever¹,

Németh

Bráth³

et al. 2010

Microsurgery

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“…Primarily, avoiding popliteal ligature would prevent CVI. Secondly, a distal anastomosis with a small AV diameter would prevent steal syndrome, as previously reported by Holman 17 , Storey 18 and Ramacciotti 19 . In our series, no steal syndrome was observed.…”

Section: Discussionmentioning

confidence: 61%

Latero-lateral femoro-femoral arteriovenous fistula: a new surgical approach for hemodialysis patients with no vascular access

et al. 2011

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Purpose: A new surgical approach for vascular access for hemodialysis using a latero-lateral arteriovenous fistula (AVF) in the thigh between the femoral artery (FA) and superficial femoral vein (SFV) transposed to the subcutaneous layer in patients with no other access options is described. Methods: Ten patients (mean age: 37,9 years) for whom all possible sites for execution of any other procedure had been exhausted, underwent latero-lateral AVF close to the adductor channel between the FA and the SFV. The FSV was released and sectioned 2 cm from its confluence with the deep femoral vein and transposed in the subcutaneous tissue with extensions using saphenous vein or prosthetic material (PTFE) when needed. Follow -up included patency, flow evaluation and complications. Results: Postoperative follow-up ranged from 3 to 96 months, with a mean of 38 months. The AVFs presented a flow of more than 350 ml/min and the AVFs remained patent for a mean period of 38 months. There were three failures of the procedures at 3, 5 and 7 months during postoperative follow-up due to graft infection and thrombosis (a case), anaphylactic shock and thrombosis (a case) and calf pain during dialysis (a case). Two patients developed slight inferior limb edema. Conclusion: The new surgical approach for access for hemodialysis represents a feasible procedure, with acceptable patency rates in exceptional cases where no other access option is available. Key words: Arteriovenous Fistula. Femoral Vein. Femoral Artery. Renal Dialysis. RESUMOObjetivo: Nova abordagem para acesso vascular para hemodiálise usando fistula artério-venosa (FAV) látero-lateral na coxa entre a artéria femoral (AF) e a veia femoral superficial (VFS) transposta no subcutâneo em pacientes sem opção de acesso. Métodos: Dez pacientes (idade média 37,9 anos), cuja possibilidade de acesso havia sido exaurido, foram submetidos a FAV látero-lateral na coxa entre a AF e a VFS.Esta veia foi liberada e seccionada 2 cm de sua confluência com a veia femoral profunda e transposta no plano superficial com extensão usando a veia safena ou material protético (PTFE) quando necessário.O seguimento incluíu a perviedade , fluxo e complicações. Resultados: O seguimento pós-operatório foi de 3 a 96 meses (média 38). A FAV apresentou fluxo mínimo de 350 ml/min e permaneceu pérvia no período médio de 38 meses. Houve 3 falências aos 3, 5, e 7 meses pós-operatórios por infecção de prótese e trombose da FAV (um caso), choque anafilático e trombose (um caso) e dor na panturrilha na hemodiálise (um caso). Dois pacientes desenvolveram discreto edema de membro inferior. Conclusão: A nova abordagem para acesso vascular para hemodiálise representa um procedimento factível, com aceitável perviedade em casos excepcionais onde nenhum outro acesso é disponível. Descritores: Fístula Arteriovenosa. Veia Femoral. Artéria Femoral. Diálise Renal. Latero-lateral femoro-femoral arteriovenous fistula. A new surgical approach for hemodialysis patients with no vascular access

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“…To the best of my knowledge, no AVF models have been described in dogs except a series of acute experiments investigating the effect of anastomotic size on fistula flow [36].…”

Section: Dog Modelmentioning

confidence: 99%

Animal Models for Studying Pathophysiology of Hemodialysis Access

Rotmans¹

2014

TOUNJ

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Despite extensive efforts, most approaches to reduce arteriovenous (AV) access-related complications did not results in substantial improvement of AV access patency thus far. Part of this disappointing progress relates to incomplete understanding of the underlying pathophysiology of hemodialysis access failure. In order to unravel the pathophysiology of hemodialysis access failure, animal models that closely mimic human pathology are of utmost importance. Indeed, it is impossible to study the extremely complex response of the AV access at a molecular and cellular level in great detail in dialysis patients. Over the past decades, numerous animal models have been developed in an attempt to unravel the vascular pathology of AV access failure and to design new therapeutic strategies aimed to improve durability of these vascular conduits. While large animals such as pigs are suitable for intervention studies, murine models have the greatest potential to gain more insight in the molecular mechanisms underlying AV access failure due to the availability of transgenic mice. In the present review, we describe several existing models of AV access failure and discuss the advantages and limitations of these models.

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Fistula Size and Hemodynamics: An Experimental Model in Canine Femoral Arteriovenous Fistulas

Abstract: These results suggest that 3.0 times the arterial diameter for the AVF size in dogs leads to greater venous flow than with 1.5 times the arterial diameter, without increasing the reversed flow.

Cited by 13 publications

References 9 publications

Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Latero-lateral femoro-femoral arteriovenous fistula: a new surgical approach for hemodialysis patients with no vascular access

Animal Models for Studying Pathophysiology of Hemodialysis Access

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