Creation of an iliac arteriovenous shunt lowers blood pressure in chronic obstructive pulmonary disease patients with hypertension.
OBJECTIVE
Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensive patients because of a reduction in vascular resistance.


METHODS
Twenty-four patients with COPD and hypertension enrolled in an open label study of arteriovenous shunt creation for COPD. We performed cardiac catheterization at baseline and again 3 to 6 months after the procedure. As a safety measure we also recorded office blood pressure at baseline and again after 3, 6, 9, and 12 months.


RESULTS
The procedure increased oxygen delivery (1.1-1.4 L.min(-1)) and cardiac output (6-8.2 L.min(-1)) (P < .001) and lowered both the systemic vascular resistance (P < .001) and the pulmonary vascular resistance (P < .01). After 12 months, however, the average systolic blood pressure was reduced from 145 to 132 mm Hg (P < .0001), and the average diastolic blood pressure was reduced from 86 to 67 mm Hg (P < .0001).


CONCLUSIONS
Percutaneous iliac arteriovenous fistula creation for COPD causes a significant and persistent lowering of blood pressure in patients with co-existing hypertension.
Asthma Research Center, BCF Diagnostics, Connolly Hospital Blanchardstown, Dublin, Ireland. Electronic address: doctorfaul@gmail.com.
John
J
Faul
Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Danny
D
Schoors
Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Sofie
S
Brouwers
Cardiology Department, ZNA Middelheim Hospital, Antwerp, Belgium.
Benjamin
B
Scott
Universitätsklinikum Giessen und Marburg, Marburg, Germany.
Andreas
A
Jerrentrup
Department of Cardiology, Mater Misericordiae Hospital and the Connolly Hospital Blanchardstown, Dublin, Ireland.
Joseph
J
Galvin
Rox Medical, Inc, San Clemente, Calif.
Sandra
S
Luitjens
Acute Stroke Unit, Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin, Ireland.
Eamon
E
Dolan
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation; D001794:Blood Pressure; D002302:Cardiac Output; D005060:Europe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007083:Iliac Artery / Q000503:physiopathology / Q000601:surgery*; D007084:Iliac Vein / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011652:Pulmonary Circulation; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D014664:Vasodilation
D010100:Oxygen