Heart Failure Due to an Arteriovenous Fistula for Hæmodialysis

George, C. R. P.; May, J.; Schieb, M. C.; Benson, R. E.; Evans, Richard A.

doi:10.5694/j.1326-5377.1973.tb110627.x

Cited by 16 publications

(5 citation statements)

References 3 publications

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“…Pandeya and Lindsay (38) propose using a ratio of Qa/CO (CPR), describing an average CPR of 22%. Published case reports of high-output cardiac failure consistently report a CPR of 30-35% (11, 39, 40) and it may be that the ratio (which takes into account the implications of high flow rather than simply the numerical value) has greater clinical significance and is better predictive of cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular changes occurring with occlusion of a mature arteriovenous fistula

et al. 2015

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The relationship between AVF blood flow, cardiac output and symptomatic cardiac disease is complex. Occlusion of an AVF leads to reduced cardiac output and improved oxygen delivery, even in asymptomatic patients. This difference is most marked in patients with high-flow AVF (>2000 mL/min). High-flow AVF with large ∆CI may lead to high cardiac output state, which is reversible on occlusion of the AVF.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular changes occurring with occlusion of a mature arteriovenous fistula

et al. 2015

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“…This approach has been used effectively since the 1960s 3 . An association between arteriovenous fistulas used for hemodialysis and the development of high‐output heart failure was first reported in the early 1970s 4,5 . The incidence of high‐output heart failure in this group of patients, however, has not been well defined.…”

Section: Discussionmentioning

confidence: 99%

“…3 An association between arteriovenous fistulas used for hemodialysis and the development of high-output heart failure was first reported in the early 1970s. 4,5 The incidence of high-output heart failure in this group of patients, however, has not been well defined. Heart failure itself is a well-recognized comorbidity among dialysis patients, and half of all deaths in the dialysis population are attributable to cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

High‐output heart failure secondary to arteriovenous fistula

Stern

Klemmer

2011

Hemodialysis International

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In the hemodialysis patient population, a surgically created arteriovenous fistula is the preferred vascular access option. Development of high-output heart failure may be an underappreciated complication in patients who have undergone this procedure. When a large proportion of arterial blood is shunted from the left-sided circulation to the right-sided circulation via the fistula, the increase in preload can lead to increased cardiac output. Over time, the demands of an increased workload may lead to cardiac hypertrophy and eventual heart failure. Patients may present with the usual signs of high-output heart failure including tachycardia, elevated pulse pressure, hyperkinetic precordium, and jugular venous distension. Typically, the AV fistula is quite large and is likely located in the upper arm, more proximal to the heart. Routine access flow monitoring should demonstrate blood flows (Qa) >2000 ML/min. Echocardiogram may reveal either a low or high left ventricular ejection fraction, and right-heart catheterization demonstrates an elevated cardiac output with a low to normal systemic vascular resistance. When addressing the problem of high-output heart failure, the nephrologist is faced with the dilemma of preventing progression of heart failure at the expense of loss of vascular access. Nevertheless, treatment should be directed at correcting the underlying problem by surgical banding or ligation of the fistula.

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“…Alternatively, heart failure may never occur or be delayed for years if the fistula is small [9][10][11]. The presence of a pre e1Cisting coronary or myocardial disease may contrib~te to the development of heart failure [12], by all oW1n: g a relatively small AVF to induce heart failure. It.…”

Section: Discussionmentioning

confidence: 99%