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Arteriovenous fistula (AVF) for the treatement of severe COPD

COPD patients have dyspnea limiting exercise capacity for different mechanisms. The gasometric anomaly is due to a V/Q missmatch causing venous admixture which has not been addressed therapeutically so far. Theoretically an AVF could increase venous content of 02 so that blood leaving the left ventricule has a higher than expected Pa02. This, along with the associated increase in cardiac output leads to an increased delivery of 02 particularly to skeletal muscle thus improving its performance.In a patient with severe COPD whom with full therapy fails to improve dyspnea and hypoxemia which limits his exercise capacity we made a peripheral arteriovenous fistula as a therapeutic intent. Spirometry shows an initial FEV1 of 0.74 l/sec, FVC of 1.97 l, hypoxemia of 56.8 mm Hg, Hb 02 saturation of 82.9%. 6MWT with a distance of 300 m (61% of predetermined value) that improved by 108 m providing 02 2 l/min. Echocardiography shows a PASP of 26 mm Hg and a 60% LV ejection fraction. The Saint George9s Respiratory Questionnaire is 73.8%, The CAT is 38 points and BODE Index is 6 points. After 4 weeks of AVF neither spyrometric nor echocardiographic changes were seen but improvement in Pa02 to 68 mm Hg and Sa02 to 93%. The 6MWT increased to 425 m. SGRQ improved 3.88 points, BODE improved to 3 points and CAT to 21 points. We conclude that AVF determines improvement in exercise capacity and better control of disease resulting in better quality of life constituting a non pharmacological aid in advanced COPD patients who fail to improve with full medical therapy. In patient selection is important to evaluate cardiovascular and peripheral vascular status since in theory AVF could lead to RV failure and peripheral blood steal syndrome.