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The Thrill of Success: Central Arterial-Venous Anastomosis for Hypertension

Current Hypertension Reports volume 16, Article number: 497 (2014) Cite this article

Abstract

Excess blood pressure remains the most important risk factor for cardiovascular and renal disease. Poly pharmacy has been proved safe and effective under clinical trial circumstances; however, the majority of patients fail to sustain pharmaceutical persistence and adherence. The opportunity to offer patients a treatment or device in addition or perhaps instead of drug therapy alone may significantly broaden the options for patients and allow greater success in hypertensive therapy. In this review, we examine the potential of a fixed-volume central arterial-venous anastomosis to reduce blood pressure in hypertensive patients, review possible mechanisms by which the anastomosis may reduce blood pressure, and consider the unique clinical trial opportunities posed by this therapy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kearney PM et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.

    PubMed  Article  Google Scholar 

  2. Chobanian AV et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52.

    CAS  PubMed  Article  Google Scholar 

  3. Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125(9):882–7 e1.

    PubMed  Article  Google Scholar 

  4. Calhoun DA et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117(25):e510–26.

    PubMed  Article  Google Scholar 

  5. Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation. 2005;112(11):1651–62.

    PubMed  Article  Google Scholar 

  6. Krum H et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373(9671):1275–81.

    PubMed  Article  Google Scholar 

  7. Faul JL et al. An arteriovenous fistula increases exercise capacity in patients with COPD. Chest. 2010;138(1):52–8. In this trial an artifiacially created arterio-venous fistula resulted in increased cardiac output, left ventricular stroke work and pulmonary vascular resistance in patients with severe COPD. The 6-minute walk distance was also significantly improved.

    PubMed  Google Scholar 

  8. Pinto-Plata VM et al. The 6-min walk distance: change over time and value as a predictor of survival in severe COPD. Eur Respir J. 2004;23(1):28–33.

    CAS  PubMed  Article  Google Scholar 

  9. Bertog SC et al. Percutaneous femoral arteriovenous shunt creation for advanced chronic obstructive pulmonary disease: a single-center safety and efficacy study. Circ Cardiovasc Interv. 2012;5(1):118–26.

    PubMed  Article  Google Scholar 

  10. Burchell AE, et al. Arteriovenous anastomosis: is this the way to control hypertension? Hypertension. 2014;64(1):6–12.

    CAS  PubMed  Article  Google Scholar 

  11. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin N Am. 2013;93(4):997–1012. x.

    PubMed  Article  Google Scholar 

  12. Roy-Chaudhury P et al. Biology of arteriovenous fistula failure. J Nephrol. 2007;20(2):150–63.

    CAS  PubMed  Google Scholar 

  13. Moua T, Wood K. COPD and PE: a clinical dilemma. Int J Chron Obstruct Pulmon Dis. 2008;3(2):277–84.

    PubMed Central  PubMed  Google Scholar 

  14. Fraisse F et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. The Association of Non-University Affiliated Intensive Care Specialist Physicians of France. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1109–14.

    CAS  PubMed  Article  Google Scholar 

  15. MacRae JM et al. Arteriovenous fistula-associated high-output cardiac failure: a review of mechanisms. Am J Kidney Dis. 2004;43(5):e17–22.

    PubMed  Article  Google Scholar 

  16. Malik J et al. Mechanisms of chronic heart failure development in end-stage renal disease patients on chronic hemodialysis. Physiol Res. 2009;58(5):613–21.

    CAS  PubMed  Google Scholar 

  17. Ori Y et al. Haemodialysis arteriovenous access—a prospective haemodynamic evaluation. Nephrol Dial Transplant. 1996;11(1):94–7.

    CAS  PubMed  Article  Google Scholar 

  18. De Lima JJ et al. Cardiac effects of persistent hemodialysis arteriovenous access in recipients of renal allograft. Cardiology. 1999;92(4):236–9.

    PubMed  Article  Google Scholar 

  19. Gorgulu N et al. Effects of arteriovenous fistula on clinical, laboratory and echocardiographic findings in renal allograft recipients. Int J Artif Organs. 2011;34(10):1024–30.

    CAS  PubMed  Article  Google Scholar 

  20. Kosmadakis G et al. Pulmonary hypertension in dialysis patients. Ren Fail. 2013;35(4):514–20.

    PubMed  Article  Google Scholar 

  21. Korsheed S et al. Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function. Nephrol Dial Transplant. 2011;26(10):3296–302. This is the first prospective study to demonstrate the hemodynamic effects of fistula formation on arterial stiffness and cardiovascular performance and function in a large cohort of patients.

    PubMed  Article  Google Scholar 

  22. Holman E. Abnormal arteriovenous communications. Great variability of effects with particular reference to delayed development of cardiac failure. Circulation. 1965;32(6):1001–9.

    CAS  PubMed  Article  Google Scholar 

  23. McBryde FD et al. The carotid body as a putative therapeutic target for the treatment of neurogenic hypertension. Nat Commun. 2013;4:2395.

    PubMed  Article  Google Scholar 

  24. Paton JF et al. The carotid body as a therapeutic target for the treatment of sympathetically mediated diseases. Hypertension. 2013;61(1):5–13.

    CAS  PubMed  Article  Google Scholar 

  25. Ashton N et al. Mechanisms involved in the activation of ischemically sensitive, afferent renal nerve mediated reflex increases in hind-limb vascular resistance in the anesthetized rabbit. Can J Physiol Pharmacol. 1994;72(6):637–43.

    CAS  PubMed  Article  Google Scholar 

  26. Winternitz SR, Oparil S. Importance of the renal nerves in the pathogenesis of experimental hypertension. Hypertension. 1982;4(5 Pt 2):III108–14.

    CAS  PubMed  Google Scholar 

  27. Schlaich MP et al. Targeting the sympathetic nervous system: critical issues in patient selection, efficacy, and safety of renal denervation. Hypertension. 2014;63(3):426–32.

    CAS  PubMed  Article  Google Scholar 

  28. Paton JF et al. Revelations about carotid body function through its pathological role in resistant hypertension. Curr Hypertens Rep. 2013;15(4):273–80.

    PubMed Central  PubMed  Article  Google Scholar 

  29. Iwashima Y et al. Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF. Am J Kidney Dis. 2002;40(5):974–82.

    CAS  PubMed  Article  Google Scholar 

  30. Hainsworth R. Cardiovascular control from cardiac and pulmonary vascular receptors. Exp Physiol. 2014;99(2):312–9.

    PubMed  Article  Google Scholar 

  31. Guyton AC, Sagawa K. Compensations of cardiac output and other circulatory functions in areflex dogs with large A-V fistulas. Am J Physiol. 1961;200:1157–63.

    CAS  PubMed  Google Scholar 

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Conflict of Interest

Alice Stanton, Eamon Dolan, and Henry Krum declare no conflict of interest. Marat Fudim is a consultant for Cibiem, Inc. Paul A. Sobotka is a consultant for Abbott Ventures, Ardian, Boston Scientific, Medtronic, Nephera, and Ardelyx and is Chief Medical Officer for Cibiem and Rox Medical.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Vanderbilt University, Nashville, TN, USA

    Marat Fudim

  2. Royal College of Surgeons in Ireland, Dublin, Ireland

    Alice Stanton & Eamon Dolan

  3. ROX Medical Inc., The Ohio State University, St Paul, MN, USA

    Paul A. Sobotka

  4. Monash University, Alfred Hospital, Melbourne, VIC, Australia

    Henry Krum

Authors
  1. Marat Fudim
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  2. Alice Stanton
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  3. Paul A. Sobotka
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  4. Eamon Dolan
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  5. Henry Krum
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Corresponding author

Correspondence to Henry Krum.

Additional information

This article is part of the Topical Collection on Device-Based Approaches for Hypertension

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Fudim, M., Stanton, A., Sobotka, P.A. et al. The Thrill of Success: Central Arterial-Venous Anastomosis for Hypertension. Curr Hypertens Rep 16, 497 (2014). https://doi.org/10.1007/s11906-014-0497-x

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  • DOI: https://doi.org/10.1007/s11906-014-0497-x

Keywords

  • Venous circulation
  • Blood volume
  • Shunt
  • Chemoreceptorsl
  • Cardio-pulmonary reflexes
  • Hypertension