Key result
Carotid-brachial pulse wave velocity was significantly lower in upper limbs with an arteriovenous fistula (10.07 m/s) compared to the contra-lateral arm without vascular access (11.55 m/s).
Why the study?
Vascular access dysfunction is common in chronically hemodialyzed patients and arterial stiffness increases in end-stage renal failure, but regional differences related to vascular access are unclear.
Does the presence of an arteriovenous fistula alter regional arterial stiffness in chronically hemodialyzed patients?
Cross-Sectional (n=38)
Does the presence of an arteriovenous fistula alter regional arterial stiffness in chronically hemodialyzed patients?
The presence of an arteriovenous fistula in chronically hemodialyzed patients is associated with lower regional arterial stiffness in the ipsilateral carotid-brachial pathway compared to the contralateral arm.
Answers are grounded in this paper and cite their sources.
Arterial stiffness measures did not predict AVF maturation failure; leaves open their clinical utility and requires larger prospective validation.
BACKGROUND: Vascular access (VA) dysfunction is a common cause of hospitalization in chronically hemodialyzed patients (CHP) limiting the improvement in health and has been largely studied in order to decrease the morbidity events that involves both the artery and the vein used in the construction of the fistula. In parallel, patients in end-stage renal failure show an increase in arterial stiffness. AIM: The aims of this work were: (a) to evaluate arterial stiffness through pulse wave velocity (PWV) measurements in the carotid-brachial pathway where the arteriovenous fistulae (AVF) was constructed, and (b) to determine possible differences in arterial stiffness between the carotid-brachial pathway with and without VA. METHODS: PWV, clinical and biochemical parameters were measured in 38 CHP. PWV was obtained in the carotid-femoral, and in the left and right carotid-brachial pathway. RESULTS: Carotid-brachial PWV determination in upper limbs with AVF (10.07 +/- ;2.43 m/s) showed significantly lower values than those observed in the contra-lateral arm without VA (11.55 +/- ;2.27 m/s). Curiously, the PWV value observed in arms with an AVF was significantly lower in diabetic than in non-diabetic hemodialyzed patients (NDHP) (8.00 +/- ;2.86 m/s and 10.38 +/- ;2.33 m/s; respectively). Measurements of PWV in the carotid-femoral pathway in CHP showed a mean value of 14.09 +/- ;3.12 m/s. Carotid-femoral PWV in NDHP (14.06 +/- ;2.44 m/s) was significantly lower than that observed in the diabetic patients (16.87 +/- ;3.42 m/s). CONCLUSIONS: Carotid-brachial PWV values obtained in the upper limbs, in which VAs were constructed, were significantly lower than that measured in intact arteries in the contra-lateral pathway in CHP.
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Fischer et al. (2009) conducted a cross-sectional in End-stage renal failure on chronic hemodialysis (n=38). Arteriovenous fistula (vascular access) vs. Contra-lateral arm without vascular access was evaluated on Carotid-brachial pulse wave velocity (PWV). Carotid-brachial pulse wave velocity was significantly lower in upper limbs with an arteriovenous fistula (10.07 m/s) compared to the contra-lateral arm without vascular access (11.55 m/s).
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