Hemodynamic Effect of Transdermal Glyceryl Trinitrate on Newly Constructed Arteriovenous Fistula

Abstract

Transdermal glyceryl trinitrate (GTN) administration may have a beneficial effect in the creation of an arteriovenous fistula (AVF) by increasing blood flow through the access and by inhibiting platelet aggregation. We evaluated the hemodynamic effects of transdermal GTN administration on newly constructed arteriovenous fistula. Radiocephalic fistula at the wrist (Brescia fistula) was constructed as the initial vascular access in 31 uremia patients (study = 16, control = 15). The patient demographics and the etiology of chronic renal disease were similar in the two groups. None of the patients had severe vasculitis. The mean duration of chronic renal disease was 8 months (1-24 months). The diameter, blood flow rate, and blood output at the drainage vein and the subclavian vein were measured by duplex ultrasonography 24 hours after the procedure. The measurements were performed again with transdermal GTN (10 mg/24 hours adhesive patch) administration in the study group and, without any medication, in the control group 4 hours after the initial measurements were taken. In the study group, all of the hemodynamic parameters were significantly increased over the initial measurements (p <0.05) whereas in the control group all hemodynamic parameters were unchanged, except the diameter of the subclavian vein (p <0.05). The actual change in hemodynamic parameters was significant in the study group when compared to the control group (p <0.05). Our data showed that transdermal GTN administration at the forearm increases flow through the Brescia fistula.

Transdermal Glyceryl Trinitrate in the Treatment of Ischemia Following Toe Deformity Correction

“…10 Transdermal GTN has become a novel therapeutic in the treatment of several noncardiac conditions including patients with Raynaud's phenomenon, 13 Achilles tendinopathy 9 and newly constructed arteriovenous fistulas. 1 Furthermore, topical nitroglycerin has been successfully used in the treatment of peripheral ischemia in neonates. 11,15 Wong et al saw the reversal of peripheral tissue ischemia caused by indwelling radial artery catheterization and extravasation of dopamine using topical nitroglycerin ointment.…”

Effects of Heparin on Early Patency of Arteriovenous Fistula in Angioaccess Surgery of Patients with End-Stage Renal Disease

“…AVF patency is affected by many factors, including but not limited to vessel diameter, patient age, and concomitant vascular disorders such as diabetes (10). Use of adjuvant medical therapies such as intraoperative heparin administration (11)(12), anti-platelet therapy (13)(14), topical glyceryl trinitrate injection (15), and postoperative flow monitoring (16) have been proposed as means of increasing patency rates, but not enough evidence currently exists to support their use, especially considering the costs and probable side effects, such as increased risk of bleeding.…”

Randomized clinical trial of the use of glyceryl trinitrate patches to aid arteriovenous fistula maturation

“…The application of GTN transdermal patches on to newly created AVFs is practised on an ad hoc basis, particularly where there are concerns about maturation. Little evidence supports this practice, although Akin and colleagues demonstrated that a locally applied GTN transdermal patch increased blood flow through the fistula after 24 h, and proposed that this application might improve maturation.…”

“…Far‐infrared therapy has the potential to improve patency and maturation, with a proposed mechanism of stimulation of nitric oxide. In experimental settings locally applied nitrate (glyceryl trinitrate, GTN) therapy has also shown promise.…”