Modulation of blood flow in the microvasculature of fingers after the formation a radiocephalic arteriovenous fistula
Abstract
Hemodialysis is the major method in renal replacement therapy. Its quality, the concurrency of complications, as well as the survival rate and rehabilitation of patients are largely determined by adequate permanent vascular access, the best option of which is the native arteriovenous fistula. A study of the flow in microvascular system of the hand after formation of arteriovenous fistula in patients with end-stage renal disease was performed by laser Doppler method. It was shown that the formation of an radiocephalic arteriovenous fistula reduces tissue perfusion below the anastomosis. Endothelial component of the microvascular tone of skin decreases, which leads to a decrease in hydrodynamic resistance microvasculature and to an increase in blood flow to the tissues of the hand. Also an increase in neurogenic microvascular tone was found. This leads to constriction of the arteriolo-venular anastomoses, an increase in capillary blood flow and to improvement in the metabolic processes in the hand tissues.
About the Authors
G. I. Lobov
Pavlov Institute of Physiology Russian Academy of Sciences
Russian Federation
Russian Federation
A. S. Gurkov
Pavlov Institute of Physiology Russian Academy of Sciences
Russian Federation
Russian Federation
References
1. Бикбов Б.Т., Томилина Н.А. Состояние заместительной терапии больных с хронической почечной недостаточностью в Российской Федерации в 1998-2009 гг. (Отчет по данным Российского регистра заместительной почечной терапии) // Нефрология и диализ. 2011. Т. 13. № 3. С. 150-264.
2. Ганеева А.Т., Ганеев Т.С. Динамика объемной скорости кровотока в сосудах после формирования артерио-венозной фистулы у больных на программном гемодиализе // Нефрология и диализ. 2007. Т.9. № 3. С. 283.
3. Крупаткин А.И., Сидоров В.В. Функциональная диагностика состояния микроциркуляторно-тканевых систем (Руководство для врачей) / М. Либроком, 2013. 496 с.
4. Лобов Г.И., Гурков А.С., Дворецкий Д.П. Микроциркуляторный кровоток в коже кисти у пациентов с артериовенозной фистулой, находящихся на лечении программным гемодиализом // Регионарное кровообращение и микроциркуляция. 2012. № 1(42). С. 35-44.
5. Мойсюк Я.Г., Беляев А.Ю. Постоянный сосудистый доступ для гемодиализа / Тверь: ООО «Издательство Триада», 2004. 153 с.
6. Рябов С.И., Наточин Ю.В. Функциональная нефрология / СПб. Изд-во «Лань», 1997. 299 с.
7. Corfield L., Muller J., Ryan J. et al. Distalization of the anastomosis: an effective treatment for dialysis access-associated steal syndrome // Ann. Vasc. Surg. 2012. Vol. 26. N 4. P. e11-e13.
8. Czupryniak A., Kałuzyńska A., Nowicki M. Raynaud’s phenomenon and endothelial dysfunction in end-stage renal disease patients treated with hemodialysis // Kidney Blood Press. Res. 2005. Vol. 28. N 1. P. 27-31.
9. Dorsett-Martin W.A. Review of microsurgery and arteriovenous fistulae for hemodialysis // Microsurgery. 2006. Vol. 26. N 2. P. 122-125.
10. Ene-Iordache B., Remuzzi A. Disturbed flow in radial-cephalic arteriovenous fistulae for haemodialysis: low and oscillating shear stress locates the sites of stenosis // Nephrol. Dial. Transplant. 2012. Vol. 27. N 1. P. 358-368.
11. Kellogg D.L. Jr1, Zhao J.L., Wu Y. et al. Nitric oxide and receptors for VIP and PACAP in cutaneous active vasodilation during heat stress in humans // J. Appl. Physiol. 2012. Vol. 113. N.10. P. 1512-1518.
12. Kimura K., Takeuchi H., Yuri K. et al. Effects of nitric oxide synthase inhibition on cutaneous vasodilation in response to acupuncture stimulation in humans // Acupunct. Med. 2013. Vol. 31. P. 74-80.
13. Korsheed S., Crowley L.E., Fluck R.J. et al. Creation of an arteriovenous fistula is associated with significant acute local and systemic changes in microvascular function // Nephron Clin. Pract. 2013. Vol. 123. N 3-4. P. 173-179.
14. Kruger A., Stewart J., Sahityani R. et al. Laser Doppler flowmetry detection of endothelial dysfunction in end-stage renal disease patients: Correlation with cardiovascular risk // Kidney Int. 2006. Vol. 70. N 1. P. 157-164.
15. Kvandal P., Stefanovska A., Veber M. et al. Regulation of human cutaneous circulation evaluated by laser Doppler flowmetry, iontophoresis, and spectral analysis: importance of nitric oxide and prostangladines // Microvasc. Res. 2003. Vol. 65. N 3. P. 160-171.
16. Nakashima Y., Fouad F.M., Nakamoto S. et al. Localization of autonomic nervous system dysfunction in dialysis patients // Am. J. Nephrol. 1987. Vol. 7. N 5. P. 375-381.
17. NKF-DOQI clinical practice guidelines for vascular access: Update 2006 // Am. J. Kidney Dis. 2006. Vol. 48. (Suppl. 1). P. S176-S247.
18. Roddie I.C. The role of vasoconstrictor and vasodilator nerves to skin and muscle in the regulation of the human circulation // Ann. R. Coll. Surg. Engl. 1963. Vol. 32. P. 180-193.
19. Rossi M., Carpi A., Ricco R. Spectral analysis of skin laser Doppler blood perfusion signal during cutaneous hyperemia in response to acetylcholine iontophoresis and ischemia in normal subjects // Clin. Hemorheol. Microcirc. 2004. Vol. 31. N 4. P. 303-310.
20. Sahin L., Gul R., Mizrak A. et al. Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas // J. Vasc. Surg. 2011. Vol. 54. N 3. P. 749-753.
21. Schanzer H., Eisenberg D. Management of steal syndrome resulting from dialysis access // Semin. Vasc. Surg. 2004. Vol. 17. N 1. P. 45-49.
22. Sheriff M.H., Naik R.B., Warren D.J. Nutritional blood flow to the limbs after access procedures // Proc. Eur. Dial. Transplant. Assoc. 1978. Vol. 15. P. 117-121.
23. Söderström T., Stefanovska A., Veber M. et al. Involvement of sympathetic nerve activity in skin blood flow oscillations in humans // Am. J. Physiol. Heart Circ. Physiol. 2003. Vol. 284. N 5. P. H1638-H1646.
24. Sriram K., Salazar Vázquez B.Y., Tsai A.G. et al. Autoregulation and mechanotransduction control the arteriolar response to small changes in hematocrit // Am. J. Physiol. Heart. Circ. Physiol. 2012. Vol. 303. N 9. P. H1096-H1106.
25. Stewart J., Kohen A., Brouder D. et al. Noninvasive interrogation of microvasculature for signs of endothelial dysfunction in patients with chronic renal failure // Am. J. Physiol. Heart Circ. Physiol. 2004. Vol. 287. N 6. P. H2687-H2696.
Review
For citations:
Lobov G.I., Gurkov A.S. Modulation of blood flow in the microvasculature of fingers after the formation a radiocephalic arteriovenous fistula. Nephrology and Dialysis. 2014;16(3):364-371. (In Russ.)
Views:
29
Email this article 