Dr Tej Singh1
1Fist Assist Devices, LLC, Los Altos, United States
Introduction: Home hemodialysis (HHD) is the future of cost saving global dialysis. Radiocephalic fistulas (RCF) are the preferred type of arteriovenous fistula (AVF) over brachiocephalic fistulas (BCF). Intermittent compression of upper arm veins may aid in forearm vein dilation.
Methods: This was an IRB approved study. After AVF creation, a novel, intermittent pneumatic compression device [Fist Assist® (FA)] was applied 15 cm proximal to AVF to apply cyclic compression of 60 mm Hg for six hours daily for 30 days. Among the patients who completed one month follow up, forty-one (n=41) AVF patients were in the study arm to test vein dilation with FA. Of these patients, twenty-four (n=24) had BCFs, while seventeen (n=17) had RCFs. Controls (n=16) 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.
Results: No patients experienced adverse effects. After one month, the mean percentage increase in vein diameter in the FA treatment group with RCFs was significantly larger than those with BCFs at proximal locations of 5 cm, 10 cm, and 15 cm from the anastomosis (p=0.001, 0.000, and 0.006, respectively) compared to the control group.
Conclusions: Early application of an intermittent pneumatic compression may be more effective at helping RCFs mature for HHD. Improved RCF maturation is important for vascular access care and has been an important goal. Successful RCF maturation may help preserve upper arm veins for future use in HHD.
Tej Singh, MD, MBA, LEAD is a Silicon Valley Vascular and Endovascular Surgeon. He is a graduate of the University of Chicago and Stanford University Business Programs. He has a busy vascular access surgical practice and now has patented technology for vein dilation. He is the CEO and Founder of Fist Assist Devices, LLC for vein dilation devices.