Early application of an intermittent pneumatic compression device is safe and results in proximal arteriovenous fistula enlargement

Abstract

Introduction: Delays in arteriovenous fistula maturation can cause care delays and increased costs. Increased distention pressure and intermittent wall shear stress may dilate veins based on prior research. Early use of non-invasive devices may help assist clinical arteriovenous fistula dilation. Methods: This was an Institutional Review Board approved study. After arteriovenous fistula creation, a novel, intermittent pneumatic compression device (Fist Assist®) was applied 15\u2009cm proximal to arteriovenous fistula enabling 60\u2009mmHg of cyclic compression for 6\u2009h daily for 30\u2009days. Among the patients who completed 1\u2009month follow-up, 30 (n\u2009=\u200930) arteriovenous fistula patients were in the study arm to test vein dilation with Fist Assist. Controls (n\u2009=\u200916) used a sham device. Vein size was measured and recorded at baseline and after 30\u2009days by duplex measurement. Clinical results (percentage increase) were recorded and tested for significance. Results: No patients experienced thrombosis or adverse effects. Patient compliance and satisfaction was high. After 1\u2009month, the mean percentage increase in vein diameter in the Fist Assist treatment group was significantly larger (p\u2009=\u20090.026) than controls in the first 5\u2009mm segment of the fistula after the anastomosis. All fistulas treated with Fist Assist are still functional with no reported thrombosis or extravasations. Conclusions: Early application of an intermittent pneumatic compression device may assist in arteriovenous fistula dilation and are safe. Non-invasive devices like Fist Assist may have clinical utility to help fistulae development and decrease costs as they may eventually assist maturation.