Banding a hemodialysis arteriovenous fistula to decrease blood flow and resolve high output cardiac failure: Report of a case

Abstract

We report herein the successful surgical treatment of a patient with high-output cardiac failure which developed from a high-flow hemodialysis arteriovenous fistula of the Brescia-Cimino type. Banding correction of the venous limb of the fistula with a woven Dacron prosthesis resulted in marked improvement of the cardiac failure. An ultrasonic study showed the fistula flow of 3.2 l/min to be as high as 40% of the resting cardiac output, or 8.0 l/min, before banding, while an intraoperative electromagnetic study was useful for controlling the degree of banding and showing the decrease of fistula flow from 3.7 l/min to 1.4 l/min.

Hemodialysis‐induced cardiovascular disease

“…Congruently, patients with AV fistula closure show a decrease in both eccentric and concentric hypertrophy . Banding and revision to reduce AV fistula blood flow can improve cardiac structure and hemodynamics …”

Successful Management of a Giant Arteriovenous Fistula with a Combination of Selective Embolization and Excision: Report of a Case

“…The clinical picture of AVMs can range from an asymptomatic birthmark to life-threatening congestive heart failure. [3][4][5][6] The case presented herein demonstrated a mild degree of cardiomegaly, although there was no previous episode of cardiac failure. The patient also complained of the gradually increasing size and dull pain of the lesion.…”

“…They are potentially fatal, rapidly enlarging, and can develop into erosive eruptions and bleeding. [1][2][3] In a case with a giant AVM, high-output cardiac failure may also develop, [3][4][5][6] with enormous shunting. Even after a complete resection, extensive defects of the skin and subcutaneous tissue are difficult to replace, because of former intervention which may jeopardize the reconstructive procedures.…”

Treatment of arteriovenous shunts after renal transplantation

“…Ahern and Maher 8 reported two cases of heart failure caused by an A-V shunt. Isoda et al 9 described the successful surgical treatment of a patient with highoutput cardiac failure caused by high vascular access fl ow, by banding the fi stula to decrease access fl ow. In this series, one patient underwent a shunt closure to treat heart failure.…”