Effect of arteriovenous pulsed pneumatic therapy on the hemodynamic microenvironment of autologous arteriovenous fistula in hemodialysis patients

Background This study aimed to evaluate the effect of arteriovenous pulsed pneumatic therapy on the hemodynamic microenvironment of autologous arteriovenous fistula (AVF) in maintenance hemodialysis patients and explore its potential to prevent AVF dysfunction. Methods A single-center observational before-and-after study enrolled 78 patients with end-to-side radiocephalic AVF and patent distal radial arteries. Under Doppler ultrasound guidance, individualized pulsed pneumatic compression was applied. Hemodynamic parameters in the AVF region were measured before and after 30 min of therapy. Computational fluid dynamics (CFD) was employed to analyze changes of wall shear stress (WSS) in the AVF before and after therapy, with focus on evaluating the effects of this treatment on WSS in the AVF anastomotic region. Results Arteriovenous pulsed pneumatic therapy increased blood flow in the distal radial artery, brachial artery, and cephalic vein. Antegrade flow in the distal radial artery was reversed to retrograde flow in 6 patients (7.7%). CFD results showed that after treatment, WSS at the anastomotic site increased by 46.5% and 30.2% compared with antegrade and retrograde flow before treatment, respectively, while the low WSS area decreased by 18.8% and 15.0%, and the oscillatory shear index remained close to zero. No adverse events were observed during treatment. Conclusion Arteriovenous pulsed pneumatic therapy increased blood flow in the distal radial artery, reversed its flow direction, and improved the hemodynamic microenvironment by increasing WSS at the anastomosis and reducing low WSS regions. These findings provide preliminary insights into its potential role in maintaining AVF function.