Antihypertensive Effects of a Central Arteriovenous Anastomosis Are Mediated Through Profound Reduction in Systemic Vascular Resistance

Device-based therapies increase therapeutic options for the treatment of hypertension for patients who fail polypharmacy because of adverse reactions or choice. Here we report the physiology related to a device, which uniquely addresses the structural pathogenesis of hypertension. Creation of a fixed-size central arteriovenous anastomosis mechanically causes an immediate and significant reduction of blood pressure (BP).1 We present the first detailed hemodynamic findings before and after implantation of the ROX Coupler.A 74-year-old white female with longstanding isolated systolic hypertension complicated by multiple drug intolerances was referred for treatment of her hypertension. She could only tolerate liquid furosemide 20 mg daily, which lowered her office BP from 220/100 mm Hg to 190/90 mm Hg. She exhibited features of raised arterial stiffness with increased pulse pressure and pulse wave velocity, and it was felt that sympathomodulation would not be beneficial for BP control. An arteriovenous anastomosis was created using the ROX coupler, inserted in a standard catheterization laboratory setting under fluoroscopic guidance via an endovascular approach through the femoral vessels (Figure 1).2 In situ, the …