Hand Exercise Effect in Maturation and Blood Flow of Dialysis Arteriovenous Fistulas Ultrasound Study

Abstract

With the help of the Doppler Ultrasound we have measured the radial artery blood flow of 20 healthy volunteers and the fistula flow of 40 uraemic patients. The measurements were made at rest and repeated one, three and five minutes after initiation of hand exercise, and one minute after the exercise had finished. Radial artery mean flow increased significantly with the exercise (p less than 0.001); radial arteries with greater baseline flow had less flow increase (p less than 0.002). However, we were not able to demonstrate any fistula flow increase with the hand exercise. Therefore, we conclude that there is no benefit in advising uraemic patients to squeeze a rubber ball which, otherwise, supposes an unnecessary preoccupation for these patients.

Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial

“…Current vascular access guidelines suggest that preoperative exercises may be helpful to improve vascular access maturation . A simple incremental resistance exercise training program could significantly increase the size of the cephalic vein commonly used in the creation of native AVF, and these exercises have been significantly related to an increase in AVF maturation …”

“…Exercises in the pre‐ and postoperative period have been recommended by current vascular access guidelines (K/DOQI) as helpful to improve vascular access maturation, increasing hyperemia and muscle mass, decreasing superficial fat, and enhancing vein prominence . Currently, preoperative exercise can increase venous diameters and is significantly related to an increase in AVF maturation . However, postoperative exercise programs (after AVF creation) have only shown increased flows and venous diameters in very short time periods; these changes have not been demonstrated to persist in time or to truly increase maturation .…”

“…Currently, preoperative exercise can increase venous diameters and is significantly related to an increase in AVF maturation . However, postoperative exercise programs (after AVF creation) have only shown increased flows and venous diameters in very short time periods; these changes have not been demonstrated to persist in time or to truly increase maturation . Only one randomized controlled trial has analyzed the effect of exercise after AVF creation, but this trial had severe limitations (few patients, excessive early examinations [2 weeks], and very low maturation rates) …”

Flow of Dialysis Fistulas

“…This explains why flow through an arterialized vein varies less than the flow through a normal artery, as we have shown by comparing AVF to normal radial artery's flow changes with a moderate hand exer cise, demonstrating that the flow does not increase in the AVF [7], This method possesses the following indications: (1) first diagnosis measure for bad functioning fistulas or unsatisfactorily dialyzed patients; (2) flow control of all good functioning fistulas, thus obtaining a baseline for subsequent comparison if any fistula or patient suffers any problem; (3) postoperative control -early and latewhen Griintzig balloon-catheter dilatation, thrombec tomy or other surgical procedures are practised; (4) de tection of deep veins and evaluation of its possible superficialization if having enough flow; (5) flow study in patients with AVF and heart failure and postoperative control if fistula banding was performed; (6) similar study to number five if steal syndrome is present, and (7) hemodynamic studies such as estimation of real flow (in mature fistulas), evolutive study of flow after AVF con struction, determining functional importance of diverse degrees of stenosis (associated to other diagnosis meth ods), etc.…”

“…Due to this dilatation and to the low pressure in the vein, the flow through the artery increases greatly, to mean values ten times those of normal radial arteries [7].…”