EFFECT OF PREOPERATIVE ISOMETRIC EXERCISES ON CEPHALIC VEIN DIAMETER IN AV FISTULA PATIENTS

Abstract

Purpose: Incidence rate of arteriovenous stula (AVF) is not very high. AVF formation is often not attempted due to small cephalic vein (CV) diameter. We hypothesized that forearm CV diameter can increase by isometric handgrip exercises and gave better results for AVF formation in AVF patients. Methods: All patients with (eGFR<25mL/min/1.73m2; CV<2.5mm) and without prior vascular access were selected. They did regular handgrip exercises in the preferred excercised arm (EA), with the nonexercised arm (NEA) as control. CV diameter was measured at baseline, by ultrasound at four and eight weeks. The primary endpoint was the mean increase in CV diameter. Secondary endpoints were mean CV diameter increase from baseline, increased proportion of potential AVF sites and successful AVF placement. Results: Atotal of 60 patients were selected and 51 nished the study. Mean CVdiameter increased in both the EAand NEAby 0.46-0.75 and 0.45- 0.60 mm, respectively. Compared to baseline, all CV diameters increased signicantly (P<.05) after four weeks. In the EA, mean distal and proximal CV increased from 1.68 to 2.43 mm and from 2.27 to 2.87 mm, respectively. The changes noted in the NEA were not signicant. There were also signicant increases in the number of sites and patients eligible for AVF formation. 16 patients had successful AVF placement. Conclusions: Isometric handgrip exercises resulted in signicant CV diameter increases after eight weeks, in the EAgroup and potentially allows for AVF formation in those not previously deemed patients.