title: Central iliac arteriovenous anastomosis for hypertension: targeting mechanical aspects of the circulation.
abstract: Raised blood pressure is the leading attributable risk factor for global morbidity and mortality. Real world data demonstrates that half of treated patients are at elevated cardiovascular risk because of inadequately controlled BP. In addition to pharmacotherapy, certain interventional strategies to reduce blood pressure and cardiovascular risk in hypertension can be considered according to international guidelines. One of the newer technologies entering this field is a proprietary arteriovenous coupler device that forms a fixed flow arteriovenous conduit in the central vasculature. In this review, we examine the development of and rationale for the creation of a central arteriovenous anastomosis in patients with hypertension and review the proposed mechanisms by which it may ameliorate hypertension. We critically review the clinical trial evidence base to date and postulate on future therapeutic directions.
authors.affiliation: Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK, v.kapil@qmul.ac.uk.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kapil
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Manish
authors.initials: M
authors.lastname: Saxena
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.forename: Charles
authors.initials: C
authors.lastname: Knight
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Alice
authors.initials: A
authors.lastname: Stanton
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Lobo
mesh_terms: D000375:Aging; D001163:Arteriovenous Anastomosis / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D012307:Risk Factors; D059289:Vascular Stiffness