Hemodynamic Consequences of Femoral Arteriovenous Bovine Shunts

Fee, Henry J.; Levisman, Jorge A.; Dickmeyer, John; Golding, Arthur

doi:10.1097/00000658-197607000-00017

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Similar hemodynamic changes and cases of HOCF were also noted in patients with femoral arteriovenous bovine shunts . Access flow in these early reports ranged from 600 ml–2.9 l/minute in the upper extremity fistulas to 2.2 l–4.9 l/minute in lower extremity shunts . The clinical manifestation of arterial “steal” incidentally began to appear in the literature by 1969 and in 2002 pulmonary hypertension from a high‐flow fistula was reported .…”

mentioning

confidence: 63%

“…It was estimated that when 20–50% of the CO was shunted through the fistula, it predisposed to cardiac failure . Similar hemodynamic changes and cases of HOCF were also noted in patients with femoral arteriovenous bovine shunts . Access flow in these early reports ranged from 600 ml–2.9 l/minute in the upper extremity fistulas to 2.2 l–4.9 l/minute in lower extremity shunts .…”

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confidence: 82%

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Complications of a High‐flow Access and Its Management

Sequeira

Tan

2015

Seminars in Dialysis

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A high-flow access has been defined as one with a flow >1-1.5 l/minute or as one where the access flow is >20% of the cardiac output. Although it may be asymptomatic, it can be associated with cardiopulmonary complications, aneurysms, central vein stenosis and the distal hypoperfusion ischemic syndrome in some patients. The decision for surgical intervention should be made after careful medical optimization especially in patients with high output cardiopulmonary compromise. In this review, we present a summary of current knowledge about the pathophysiology of a high-flow fistula, followed by a concise, comprehensive synopsis of current medical and surgical therapy.

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confidence: 63%

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confidence: 82%

Complications of a High‐flow Access and Its Management

Sequeira

Tan

2015

Seminars in Dialysis

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“…Early studies on shunt creation for dialysis access documented that high-output cardiac failure can develop with excessive shunt flow, which necessitates either banding or ligation of the shunt. 18,19 With the ROX Coupler system, the device is first introduced percutaneously. Once a shunt is created to connect the iliac artery and vein, the device is then implanted to keep the shunt patent.…”

Section: Arteriovenous Shunt (Rox Coupler)mentioning

confidence: 99%

Carotid Baroreceptor Stimulation and Arteriovenous Shunts for Resistant Hypertension

Paivanas

Bisognano

Gassler

2015

Methodist DeBakey Cardiovascular Journal

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Pharmacologic therapy for hypertension is effective for the majority of patients with hypertension, but there is a subset of the population with treatment-resistant hypertension who cannot achieve their blood pressure goal despite taking multiple medications. Since these patients are at increased risk of cardiovascular disease and end-organ damage, additional therapies must be considered. This review discusses several novel interventional therapies-including baroreflex activation therapy, baroreceptor stenting, and creation of an arteriovenous shunt-that may provide alternative options for blood pressure control in those with treatment-resistant hypertension. All of these therapies remain investigational, and each has its own strengths and weaknesses that will be critical to assess as they come to market.

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“…• Femro-femoral suprainguinal crossover AVG between the femoral artery and the contralateral femoral vein [51].…”

Section: Hemodialysismentioning

confidence: 99%

Vascular Access for Hemodialysis - How to Maintain in Clinical Practice

Elwakeel¹,

Elalfy²

2013

Hemodialysis

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The physiologic effects of AV fistulas can be separated into local haemodynamic effects and systemic cardiovascular effects [7]. • Local haemodynamic effects: The effect of creating a fistula on the proximal artery is similar to making a hole in a dike. Flow in the proximal artery increases markedly in response to the sudden decrease in outflow pressure afforded by the fistula, so with forearm AV fistulas, brachial artery flow may increase 5 to 10 folds [8]. In the distal artery, the situation is not so simple. With small fistula, distal artery flow is maintained antegrade, away from the heart. With increasing fistula size, however, distal artery flow decreases until it reaches a standstill when the anastomotic length is equal to the proximal artery diameter. At this point, circus motion develops with antegrade flow during systole and retrograde flow during diastole through the fistula into the venous limbs. When the anastomotic length of the fistula communication increases, above the diameter of the proximal artery, reversed flow in the distal artery increases until it exceeds the antegrade flow [9]. • Systemic haemodynamic effects: The immediate effect of opening a fistula is to divert blood flow away from the rest of the peripheral circulation and into a special low-resistance path directly connecting the left side to the right side of the heart. Cardiac output increases acutely via increased rate and stroke volume. Arterial pressure falls, and heart rate increases; these changes are minimal with lowflow fistulas and increase with increasing fistula flow. Cardiac work also increases [10]. 4. Preoperative evaluation 4.1. Patient preparation for permanent hemodialysis access (modified from NKF, 2006 [ 11 ]) Good planning allows initiation of dialysis at the proper time with a permanent functioning access in place ready at the start of dialysis. • Patients with a glomerular filtration rate (GFR) less than 30 mL/min/1.73 m 2 and chronic kidney disease (CKD) stage 4 should be educated about all modalities of kidney replacement therapy (KRT) options, including transplantation, so that timely referral can be made for the appropriate modality and placement of a permanent dialysis access, if necessary.

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Hemodynamic Consequences of Femoral Arteriovenous Bovine Shunts

Cited by 7 publications

References 10 publications

Complications of a High‐flow Access and Its Management

Complications of a High‐flow Access and Its Management

Carotid Baroreceptor Stimulation and Arteriovenous Shunts for Resistant Hypertension

Vascular Access for Hemodialysis - How to Maintain in Clinical Practice

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