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.