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November 2, 1970

Control of Arteriovenous Shunt Flow

Author Affiliations

From the departments of medicine (Drs. Alfrey, Lueker, Goss, Vogel, and Holmes) and surgery (Dr. Faris), University of Colorado School of Medicine, Denver. Dr. Alfrey is now at the University of Texas (Southwestern) Medical School, Dallas. Drs. Lueker and Goss are now with the; University of New Mexico School of Medicine, Albuquerque. Dr. Vogel is now with the Santa Barbara (Calif) Heart and Lung Institute.

JAMA. 1970;214(5):884-888. doi:10.1001/jama.1970.03180050040007

The conditions of 25 patients with external arteriovenous shunts were studied to determine the factors important in control of shunt flow. Shunt flow varied between 1.9% and 9.8% of the cardiac output in seven studies performed in five patients. Change in posture, exercise, and dialysis had no consistent effect on shunt flow. Flow was primarily determined by systemic pressure, vascular reactivity, and the state of the cannulated vessels. Cold pressor test and angiotensin amide consistently increased flow in contrast to the fall in flow and increased shunt pressure induced with sympathomimetic agents. Studies in dogs demonstrated that the changes induced with the sympathomimetic agents were a consequence of arterial and venous constriction mediated through alpha-adrenergic receptors. Shunt flow and pressure measurements appeared to be useful in predicting shunt survival and determining the involved side of a malfunctioning shunt.