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Original Research: COPD |

An Arteriovenous Fistula Increases Exercise Capacity in Patients With COPD

John L. Faul, MD, FCCP; Juan Galindo, MD; Rodolfo Posadas-Valay, MD, MPH, FCCP; Guillermo Elizondo-Riojas, MD; Angel Martinez, MD; Christopher B. Cooper, MD, FCCP
Author and Funding Information

From the Asthma Research Centre (Dr Faul), Blanchardstown Connolly Hospital, Dublin, Ireland; the Departments of Pulmonary Medicine (Drs Galindo and Posadas-Valay), Radiology (Dr Elizondo-Riojas), and Surgery (Dr Martinez), University Hospital, Madero y Gonzalitos, Monterrey, Nuevo Leon, Mexico; and the Division of Pulmonary and Critical Care Medicine at the David Geffen School of Medicine (Dr Cooper), University of California, Los Angeles, Los Angeles, CA.

Correspondence to: Christopher B. Cooper, MD, FCCP, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, 37-131 CHS, Los Angeles, CA 90095-1690; e-mail: ccooper@mednet.ucla.edu


Drs Faul and Galindo contributed equally to the study design and execution of this work.

Funding/Support: This work was supported by ROX Medical, San Clemente, CA.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):52-57. doi:10.1378/chest.09-2381
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Background:  Supplemental oxygen usually increases exercise capacity in hypoxemic COPD, but some patients are refractory because of venous admixture. An arteriovenous fistula (AVF) with left-to-right shunt increases mixed venous oxygen content and cardiac output; therefore, this might improve arterial oxygen delivery. We hypothesized that creation of an AVF would therefore increase exercise capacity in severe COPD.

Methods:  We created an AVF in 12 patients with severe hypoxemic COPD: mean (SD) age, 66 (6) years; Pao2, 57.5 (3.0) mm Hg, and FEV1, 19% (8%) predicted. We measured 6-min walk distance (6MWD) while the subjects were breathing room air and again while they were breathing portable supplemental oxygen at baseline, 6 weeks, and 12 weeks after creation of an AVF in the iliofemoral region.

Results:  After surgery, the mean (SEM) 6MWD increased from 217 (63) m at baseline to 272 (18) m and 276 (25) m, 6 weeks and 12 weeks after surgery, respectively. Patients who walked > 54 m further while breathing supplemental oxygen at baseline (n = 5) increased 6MWD while breathing room air by 129 (34) m after 6 weeks (P = .02) and by 124 (29) m after 12 weeks (P = .004). Walking distance did not change in patients who did not have a clinically meaningful response to oxygen at baseline.

Conclusions:  An iliofemoral AVF increased 6MWD patients with severe COPD, matching the improvement seen with supplemental oxygen. An initial response to supplemental oxygen predicted a therapeutic response to the AVF.

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