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01-03-2018 | Mechanisms of Hypertension (M Weir, Section Editor)

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

Authors: Stefan C. Bertog, Nathan A. Sobotka, Paul A. Sobotka, Melvin D. Lobo, Kolja Sievert, Laura Vaskelyte, Horst Sievert, Roland E. Schmieder

Published in: Current Hypertension Reports | Issue 3/2018

Abstract

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.

Summary

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.

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Title: Percutaneous Creation of a Central Iliac Arteriovenous Anastomosis for the Treatment of Arterial Hypertension
Authors: Stefan C. Bertog
Nathan A. Sobotka
Paul A. Sobotka
Melvin D. Lobo
Kolja Sievert
Laura Vaskelyte
Horst Sievert
Roland E. Schmieder
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Hypertension Reports / Issue 3/2018
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI: https://doi.org/10.1007/s11906-018-0816-8

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