Percutaneous Creation of a Central Iliac Arteriovenous Anastomosis for the Treatment of Arterial Hypertension

  • Stefan C. Bertog
  • Nathan A. Sobotka
  • Paul A. Sobotka
  • Melvin D. Lobo
  • Kolja Sievert
  • Laura Vaskelyte
  • Horst Sievert
  • Roland E. Schmieder
Mechanisms of Hypertension (M Weir, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Mechanisms of Hypertension


Purpose of Review

Provision of a summary on the physiologic effects of arteriovenous fistula creation and description of previously published human data on the efficacy of a percutaneously implanted device creating an arteriovenous fistula. Though antihypertensive therapy is effective, some patient’s blood pressure remains poorly controlled despite adherence to optimal medical therapy. Moreover, some patients are not compliant with recommended medical therapy due to side effects or personal decision. This has prompted exploration of alternative, device-based antihypertensive therapies including, among others, the percutaneous creation of an arteriovenous fistula. An arteriovenous fistula is accompanied by a number of favorable physiologic changes that may lower blood pressure. These physiologic changes, conduction of the procedure, and previously published human experience are summarized in this review article.

Recent Findings

The results of a recently published trial comparing arteriovenous fistula creation and standard antihypertensive therapy versus standard antihypertensive therapy alone are summarized.


Creation of an arteriovenous fistula is accompanied by a significant blood pressure reduction likely related to a reduction in total arterial resistance, perhaps blood volume reduction, inhibition of the baroreceptor reflex, and release of natriuretic peptides. These findings foster further interest in studying the impact of an arteriovenous fistula and arterial blood pressure. The design of a large randomized trial comparing arteriovenous fistula creation to sham control is outlined.


Hypertension Arteriovenous anastomosis Arteriovenous fistula Resistant hypertension Dialysis 


Compliance with Ethical Standards

Conflict of Interest

Dr. Stefan Bertog has received reimbursement for travel expenses or study honoraria from Ablative Solutions, Johnson and Johnson, and Medtronic.

Nathan Sobotka is a member of Paul Sobotka’s immediate family.

Dr. Paul Sobotka is chief medical officer of ROX Medical Inc. with both salary and stock.

Dr. Melvin Lobo reports personal fees from ROX Medical during the conduct of the study and personal fees from CVRx, personal fees from Cardiosonic, personal fees from St Jude Medical, and personal fees from KONA Medical, outside the submitted work.

Dr. Kolja Sievert has nothing to disclose.

Laura Vaskelyte has nothing to disclose.

Dr. Horst Sievert has received consulting fees, reimbursement for travel expenses or study honoraria from the following companies: Abbott, Ablative Solutions, Ancona Heart, Bioventrix, Boston Scientific, Carag, Cardiac Dimensions, Celonova, Cibiem, CGuard, Comed B.V., Contego, CVRx, Edwards, Gardia, Hemoteq, InspireMD, Kona Medical, Lifetech, Maquet Getinge Group, Medtronic, Occlutech, pfm Medical, Recor, St. Jude Medical, Terumo, Trivascular, Vascular Dynamics, Venus, and Veryan.

Schmieder RE reports grants from Rox Medical to the institution, outside the submitted work.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Supplementary material (15.3 mb)
Video 1 Crossing from the external iliac vein into the external iliac artery via a curved needle and advancement of a 0.018-in. wire into the external iliac artery. (MOV 15705 kb) (7.5 mb)
Video 2 Deployment of the arterial portion of the ROX coupler. (MOV 7708 kb) (9.4 mb)
Video 3 Deployment of the venous portion of the ROX coupler. (MOV 9652 kb) (3.9 mb)
Video 4 Balloon dilatation with a 4-mm balloon to establish flow. (MOV 4001 kb) (1.7 mb)
Video 5 Final angiography demonstrating a fistulous connection between the external iliac artery and vein. (MOV 1698 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018
corrected publication April/2018

Authors and Affiliations

  • Stefan C. Bertog
    • 1
    • 2
  • Nathan A. Sobotka
    • 2
  • Paul A. Sobotka
    • 3
    • 4
  • Melvin D. Lobo
    • 5
  • Kolja Sievert
    • 1
  • Laura Vaskelyte
    • 1
  • Horst Sievert
    • 1
  • Roland E. Schmieder
    • 6
  1. 1.CardioVascular CenterFrankfurtGermany
  2. 2.St Paul Academy and Summit SchoolSt PaulUSA
  3. 3.ROX Medical Inc.San ClementeUSA
  4. 4.Department of Medicine, Division of CardiologyThe Ohio State UniversityColumbusUSA
  5. 5.NIHR Biomedical Research Centre at BartsBarts Health NHS Trust and Queen Mary University of LondonLondonUK
  6. 6.Department of Nephrology and HypertensionUniversity Hospital, Friedrich-Alexander University Erlangen-NurembergErlangenGermany

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