Document Detail


Effect of a femoral arteriovenous fistula on lower extremity venous hemodynamics after femorocaval reconstruction.
MedLine Citation:
PMID:  8918326     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To study the hemodynamic effects of an arteriovenous fistula (AVF) used as an adjunct to venous reconstructions and to determine the optimal size for such a fistula.
METHODS: A model of limb circulation with an AVF (in vitro system) was constructed with silicon elastic tubes and 40% glycerin solution as the fluid medium. Pulsatile arterial flow and venous return was maintained with a roller pump and a centrifugal assist device. Flows and pressures were measured for three different fistula diameters (3, 4, and 5 mm). A canine model of venous hypertension with outflow obstruction was constructed in 15 adult mongrel dogs. After 7 to 13 days an externally supported 8-mm expanded polytetrafluoroethylene femorocaval graft was implanted with a distal AVF (3 mm, n = 5; 4 mm, n = 5; 5 mm, n = 5). Arterial and venous flows and venous pressures were measured proximal and distal to the fistula before and after exercise.
RESULTS: In the in vitro system, flows through the venous graft increased with increasing fistula size, but venous return decreased progressively, increasing the distal venous pressure. In the canine model, flow in the venous graft increased with each AVF (p < 0.01). Only the 3-mm AVF resulted in decreased distal femoral vein pressure (p < 0.01), orthograde flow, and improved venous return with exercise.
CONCLUSION: AVFs increased flow through the femorocaval grafts, yet they impeded venous return. The ideal AVF-to-graft ratio used in our study was 0.375, because it increased graft flow, permitted forward flow in the femoral vein while reducing pressure, and improved venous return with exercise.
Authors:
S S Menawat; P Gloviczki; G Mozes; D Whitley; W J Anding; R D Serry
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  24     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1996 Nov 
Date Detail:
Created Date:  1996-12-18     Completed Date:  1996-12-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  793-9     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Arteriovenous Shunt, Surgical*
Chronic Disease
Disease Models, Animal
Dogs
Electric Stimulation
Extremities / blood supply*
Femoral Artery / physiology*,  surgery
Femoral Vein / physiology*,  surgery
Humans
Hypertension / physiopathology
Models, Anatomic
Pulsatile Flow
Random Allocation
Regional Blood Flow
Veins
Vena Cava, Inferior / physiology*,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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