The complex relationship among arteriovenous access, heart, and circulation

Basile, Carlo; Lomonte, Carlo

doi:10.1111/sdi.12652

Cited by 21 publications

(26 citation statements)

References 51 publications

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“…However, after the initial drop, SaO 2 and PaO 2 levels increased to slightly higher than baseline SaO 2 , both in this study and that of Meyring‐Wosten This may have been due to an improvement in fluid status resulting in less pulmonary congestion and a reduced A‐a oxygen gradient . Interestingly, regarding long‐term effects, the creation of an arteriovenous fistula may improve arterial oxygenation through cardio‐pulmonary recirculation, although to the best of our knowledge this effect has only been studied in patients with COPD, and not in renal patients …”

Section: Changes In Arterial Oxygen Saturation During Dialysismentioning

confidence: 56%

“…55 Interestingly, regarding long-term effects, the creation of an arteriovenous fistula may improve arterial oxygenation through cardio-pulmonary recirculation, although to the best of our knowledge this effect has only been studied in patients with COPD, and not in renal patients. 56,57 11 | POSSIBLE COMPLICATION S OF HYPOXEMIA Therefore, whereas the HD procedure appears to have bimodal effects on SaO 2 and the pathophysiological effects of the initial drop appears to have been elucidated, patient-related factors undoubtedly also play a major role in persistent hypoxemia during HD as outlined previously. The consequences of prolonged arterial hypoxemia remain unexamined.…”

Section: Saturation During Dialysismentioning

confidence: 94%

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Hemodialysis: A model for extreme physiology in a vulnerable patient population

Kooman

Katzarski

Sande

et al. 2018

Seminars in Dialysis

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Hemodialysis (HD) is a lifesaving treatment for patients with end-stage renal disease, which is very efficient in the correction of abnormalities of the internal environment. However, this efficiency also induces significant hemodynamic, thermal, and respiratory stressors. These have parallels with the extreme physiologic demands which are normally mainly experienced by healthy subjects under adverse environmental conditions, with the difference that they must be endured by a vulnerable patient population. Hemodynamic stress induced by ultrafiltration leads to a decline in circulating blood volume, which may result in intradialytic hypotension (IDH) and changes in tissue perfusion, which may have long-term consequences for the function of vital organs such as the brain and the heart. Pronounced declines in central venous oxygen saturation have been observed during routine HD, which are related to the circulatory stress imposed upon the patient. Apart from patient-related factors, thermal stress induced by HD may lead to skin vasodilation, counteracting the normal hemodynamic response to hypovolemia, which has important pathophysiologic correlates in heat syncope. Lastly, respiratory stress is reflected by prolonged arterial hypoxemia during HD, which is both related to patient-related factors, but may also be partly because of the treatment itself, especially during the first 30-60 minutes. Whereas hypoxemia during HD is related to increased mortality, its role in the reduced tissue oxygen delivery during HD should be further defined. Treatment modifications, such as cool or temperature-controlled HD, may reduce circulatory and thermal stress, which also may translate into a reduced risk of long-term cardiac or cerebral damage. However, as circulatory stress is mainly time-dependent, prolonged, or more dialysis treatment may reduce the homeostatic burden on the patient.

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Section: Changes In Arterial Oxygen Saturation During Dialysismentioning

confidence: 56%

Section: Saturation During Dialysismentioning

confidence: 94%

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Kooman

Katzarski

Sande

et al. 2018

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…However, the preventive effect of flow reduction on heart failure has not yet been confirmed. 6 ) A prospective study has reported that flow volumes greater than 2 l/min were strongly correlated with the occurrence of high output heart failure. 8 ) Thus, according to the high predictive power of the study mentioned above, it is possible that flow reduction prevented potential heart failure in two of the three patients in our study who had a flow volume greater than 2 l/min.…”

Section: Discussionmentioning

confidence: 99%

“…High flow access (HFA) for hemodailysis can occasionally lead to disorders such as venous hypertension, 1 , 2 ) hemodialysis access-induced distal ischemia (HAIDI), 3 – 5 ) and high output heart failure 6 – 9 ) ; therefore, accurate diagnosis and appropriate treatment are essential to limit subsequent complications. 10 ) While radical treatment for HFA involves access closure, flow reduction procedures are used to preserve access.…”

Section: Introductionmentioning

confidence: 99%

Graft Inclusion Technique: A New Flow Reduction Procedure for High Flow Arteriovenous Fistulae

Nojima

Motomiya²

2018

Annals of Vascular Diseases

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Objective: Flow reduction is required to preserve vascular access in cases with high flow access (HFA). We report a new flow reduction procedure, the graft inclusion technique (GIT).Methods: The GIT procedure developed by us involves the intraluminal placement and suturing of a 4-mm polytetrafluoroethylene graft to the anastomosis and outflow tract to plicate the enlarged anastomosis and maintain lower flow volumes. Flow reduction for HFA was retrospectively assessed in a series of 25 patients (age 65±12 years; 17 males and 8 females) to evaluate flow volume and patency rate, wherein 10 patients underwent conventional methods of flow reduction and 15 underwent GIT.Results: Compared with preprocedure values, mean flow volume (MFV) was significantly lower after the procedure with both the conventional methods (1,817 vs. 586 ml/min; P<0.05) and the GIT (2,262 vs. 890 ml/min; P<0.05). An increase in MFV occurred during follow-up after conventional flow reduction (586 vs. 1,036 ml/min), while GIT could maintain lower MFV (890 vs. 791 ml/min), suggesting that GIT can significantly lower MFV levels (2,262 vs. 791 ml/min; P<0.05) and maintain these lower MFV levels during follow-up. Secondary patency rate for the GIT was 100% at 1 year and 83% at 3 years.Conclusion: The GIT may be used as an access-preserving, reliable, long-term, and stable flow-reducing procedure that does not require flow adjustment during surgery.

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“…A recent multicenter, observational cohort study in 602 participants identified AFV blood flow rate, diameter, and depth as moderate predictors of AVF maturation [21]. However, there are no generally agreed upon hemodynamic criteria for determining AVF maturity and cardiovascular adaptation to the AVF [22]. Additionally, there is no agreed upon process to follow fistula maturation and attempt cannulation based on prior hemodynamic information.…”

Section: Introductionmentioning

confidence: 99%

Tracking Arteriovenous Fistula Maturation: A Novel Approach

et al. 2018

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Background: The time between the creation of an arteriovenous fistula (AVF) and its successful use is significantly longer in hemodialysis (HD) patients in the United States compared to those in other countries, and there is an urgent need to reduce the residence time of central-venous catheters (CVC). Methods: Successful AVF creation and maturation results in typical hemodynamic changes, such as an increase in cardiac output and upper body blood flow (UBBF). In patients with CVC as vascular access, we measured once per minute intradialytic central-venous oxygen saturation (ScvO₂) and hemoglobin levels simultaneously using the Crit-Line Monitor. Under conditions of stable upper body oxygen consumption and arterial oxygen saturation, ScvO₂ and hemoglobin concentration allows the calculation of estimated UBBF (eUBBF). In a quality improvement project, we used ScvO₂ and eUBBF to track the hemodynamic changes accompanying AVF maturation. Results: Out of 11 patients (9 incident to HD, 1 female, age 61 ± 13 years), AVF maturation was successful in 9. In 1 patient, the AVF did not mature. One patient died from sudden cardiac death with a maturing AVF. In the 9 patients with successful AVF maturation, ScvO₂ increased from 60.9 ± 2.7% prior to AVF creation to 73.4 ± 3.6% a week after AVF creation (19.6 ± 6.3% increase). eUBBF increased from 1.3 ± 0.3 to 2.2 ± 0.6 L/min (62.7 ± 37.5% increase); no material ScvO₂ or eUBBF changes occurred in the other 2 patients. Conclusion: Our results indicate the potential utility of ScvO₂ and eUBBF to track the hemodynamic response to AVF maturation. To what extent these insights translate into shortening of the time between AVF creation and successful cannulation warrants further investigations.

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The complex relationship among arteriovenous access, heart, and circulation

Cited by 21 publications

References 51 publications

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Graft Inclusion Technique: A New Flow Reduction Procedure for High Flow Arteriovenous Fistulae

Tracking Arteriovenous Fistula Maturation: A Novel Approach

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