Effect of a Surgically Created Side-to-Side Arteriovenous Fistula on Heat Elimination from the Human Hand and Forearm: Evidence for a Critical Role of Venous Resistance in Determining Fistular Flow

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Abstract
In 8 patients with a unilateral fistula between the radial artery and a nearby superficial vein, heat elimination from both hand and forearm as measured by calorimetry was always substantially greater on the side of the fistula (mean excess from hand-plus-forearm 889 J/min). Fistular blood flow measured by hand-plus-forearm plethysmography in these patients averaged 431 ml/min. Correlation between fistular blood flow and heat elimination was poor (r = 0.70, P < 0.06), probably because heat elimination due to the fistula takes place mainly from veins, whose pattern varies from patient to patient. Approximately half of the total increased heat elimination due to the fistula is from the hand. Occlusion of the circulation to the hand caused fistular flow rate to be reduced by about half. Apparently the main resistance to fistular flow is venous, proximal veins offering a similar resistance to distal veins. The obligatory heat loss due to the fistula is unlikely to alter temperature regulation, except in severe cold stress.

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