Abstract: FR-OR044

Intermittent Pneumatic Compression Increases Forearm AV Fistula Dilation: The First Medical Wearable for the Renal Community

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Author

  • Singh, Tej M., El Camino Hospital, Mountain View, California, United States
Background

Delays in AV fistula (AVF) maturation cause increased catheter dependency and costs. Forearm fistulas have very poor maturation rates compared to upper arm AVF. Increased distention pressure, nitric oxide release, and intermittent wall shear stress may help dilate forearm veins after AVF creation. Early use of non-invasive devices may help assist clinical AVF maturation and dilation.

Methods

One week after AVF creation, a novel, intermittent pneumatic compression device [Fist Assist (FA)] was applied 15 cm proximal to the AVF in order to apply intermittent, cyclic compression for 60 mm Hg for six hours daily for 30 days. Fourty (n=46) AVF patients were enrolled in an IRB approved study to test vein maturation at baseline and with the FA. Controls (n=17) used a sham device. Vein size was measured and recorded at baseline and after 30 days by duplex measurement. Clinical results (percentage increase) were recorded and tested for significance using standard t-tests.

Results

No patients experienced immediate thrombosis or adverse effects. Patient compliance and satisfaction was high. After one month, the mean percentage increase in vein diameter in the FA treatment group for all fistulas was significantly larger (p=0.05) than controls in the first 5 mm segment of the AVF vein . Forearm AVF veins dilated in all segments of the veins compared to upper arm veins. In the midportion alone,veins dilated compared to upper arms (39+35% vs. 94+44%) (p<.05). No fistulas had complications on dialysis or after needle placement.

Conclusion

Early application of an intermittent pneumatic compression device may assist in AVF maturation and success. Novel, non-invasive devices like Fist Assist may have clinical utility to create functional fistulae development and decrease costs as they may assist in maturation. FA may assist in forearm vein dilation and may provide the first wearable for the renal community to assist in AVF dilation especially at the forearm vein region.