BACKGROUND: Native arteriovenous fistulae (AVF) are the vascular access of choice for haemodialysis. The consequences of AVF formation on microvascular function, locally or systemically, are unknown. METHODS: We recruited 43 predialysis patients undergoing AVF formation. Patients were studied 2 weeks prior to the planned AVF operation and 2 weeks postoperatively. Thirteen patients with failed AVF were subsequently utilised as sham controls. Laser Doppler perfusion imaging was used to measure subcutaneous microvascular blood flow. Microvascular function was assessed as an increase in perfusion in response to iontophoretic administration of vasodilatory stimuli assessing endothelial-dependent (ED) and non-endothelial-dependent (NED) vasodilatation. RESULTS: Patients with successful AVF formation had a significantly reduced ED vasodilatation in the fistula arm (-36 ± 46%, p < 0.001). Only NED vasodilatation was significantly reduced in the non-fistula arm (23 ± 40%, p = 0.01). Patients who had an unsuccessful AVF operation exhibited no recordable changes. CONCLUSIONS: Formation of an AVF was associated with local and remote changes in microcirculation. Further assessments are underway to examine the contributions of local shear stress, vasoreactive substances and the autonomic responses. Although the clinical significance of these findings is not yet clear, it is intriguing that AVF formation is associated with such widespread and profound changes in microperfusion.
BACKGROUND: Native arteriovenous fistulae (AVF) are the vascular access of choice for haemodialysis. The consequences of AVF formation on microvascular function, locally or systemically, are unknown. METHODS: We recruited 43 predialysis patients undergoing AVF formation. Patients were studied 2 weeks prior to the planned AVF operation and 2 weeks postoperatively. Thirteen patients with failed AVF were subsequently utilised as sham controls. Laser Doppler perfusion imaging was used to measure subcutaneous microvascular blood flow. Microvascular function was assessed as an increase in perfusion in response to iontophoretic administration of vasodilatory stimuli assessing endothelial-dependent (ED) and non-endothelial-dependent (NED) vasodilatation. RESULTS:Patients with successful AVF formation had a significantly reduced ED vasodilatation in the fistula arm (-36 ± 46%, p < 0.001). Only NED vasodilatation was significantly reduced in the non-fistula arm (23 ± 40%, p = 0.01). Patients who had an unsuccessful AVF operation exhibited no recordable changes. CONCLUSIONS: Formation of an AVF was associated with local and remote changes in microcirculation. Further assessments are underway to examine the contributions of local shear stress, vasoreactive substances and the autonomic responses. Although the clinical significance of these findings is not yet clear, it is intriguing that AVF formation is associated with such widespread and profound changes in microperfusion.
Authors: Jack M J Pickard; Hans Erik Bøtker; Gabriele Crimi; Brian Davidson; Sean M Davidson; David Dutka; Peter Ferdinandy; Rocky Ganske; David Garcia-Dorado; Zoltan Giricz; Alexander V Gourine; Gerd Heusch; Rajesh Kharbanda; Petra Kleinbongard; Raymond MacAllister; Christopher McIntyre; Patrick Meybohm; Fabrice Prunier; Andrew Redington; Nicola J Robertson; M Saadeh Suleiman; Andrew Vanezis; Stewart Walsh; Derek M Yellon; Derek J Hausenloy Journal: Basic Res Cardiol Date: 2014-12-02 Impact factor: 17.165
Authors: Siew Cheng Chai; Zulkefli Sanip; Aida Hanum Ghulam Rasool; Amran Ahmed Shokri; Ahmad Sukari Halim; Arman Zaharil Mat Saad; Wan Azman Wan Sulaiman Journal: J Res Med Sci Date: 2022-06-30 Impact factor: 1.985