The use of a novel ROX central arteriovenous fistula formation device in a patient with severe drug-resistant hypertension and prior aortic graft.

We report a case of the successful use of a central arteriovenous (cAV) coupler device to treat severe drug-resistant primary hypertension in a 46-year-old female. The device is inserted via a femoral approach to create an ateriovenous fistula between the external iliac artery and vein and has shown promise in the treatment of severe hypertension. The patient's 24-hr ambulatory blood pressure (ABP) pre device insertion on eleven anti-hypertensive medications revealed a mean 24-hr ABP of 165/98 mm Hg. The insertion of the cAV coupler resulted in a sustained anti-hypertensive effect nine months post-procedure, with mean 24-hr ABP of 154/91 mm Hg on only two anti-hypertensives. Her significant anti-hypertensive response may be explained by the presence of an inelastic aortic graft that had been inserted due to prior aortic dissection as it allowed the restoration of elasticity in a previously inelastic arterial system. We believe that the ROX cAV coupler device warrants further investigation.