Cardiac Failure Following Traumatic Arteriovenous Fistula: A Report of Fourteen Cases

Pate, James W.; Sherman, Roger T.; Jackson, T. G.; Wilson, Harwell

doi:10.1097/00005373-196505000-00011

Cited by 21 publications

(12 citation statements)

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“…8 In such patients, cardiac failure may not resolve after closure of the fistula. 9 In our patient, the SVRI increased (2.6 fold) and the CI decreased (0.6 fold) following clamping of the iliac artery, and the PCWP increased from 15 to 32 mmHg. The patient had no chest pain and ECG showed no ST-T change.…”

Section: Discussionmentioning

confidence: 45%

Perioperative management of biventricular failure after closure of a long-standing massive arteriovenous fistula

Nara

Yoshikawa

Saito

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: To report the perioperative management of arteriovenous fistula (AVF) closure in a patient with high-output heart failure and pulmonary hypertension.Clinical features: In a 71-yr-old man, closure of a long-standing massive AVF between the right femoral artery and vein was performed. After closure of the AVF, his pulmonary artery pressure (PAP) increased from 52/21 mmHg to 68/26 mmHg, his cardiac index decreased from 5.27 L·min -1 ·m -2 to 3.18 L·min -1 ·m -2 , and his pulmonary wedge pressure increased from 15 mmHg to 32 mmHg due to an acute increase in afterload. Co-administration of prostaglandin E 1 and a phosphodiesterase III inhibitor improved the cardiac index and the PAP.Conclusions: Surgical closure of the fistula may not always lead to resolution of the high output cardiac failure. In this case, afterload management using arterial dilators (prostaglandin E 1 , phosphodiesterase III inhibitor), use of inotropic drugs (phosphodiesterase III inhibitor), and close attention to volume status was crucial for a successful outcome after surgical AVF closure.

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Section: Discussionmentioning

confidence: 45%

Perioperative management of biventricular failure after closure of a long-standing massive arteriovenous fistula

Nara

Yoshikawa

Saito

et al. 2001

Can J Anesth/J Can Anesth

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“….all arteriovenous fistulae, no matter how small, be repaired'. On the other hand, in a review [11] of fourteen cases of cardiac failure out o f 44 cases o f traumatic arterio venous fistulae, heart failure never occurred with AVF of minor ves sels (intercostal, brachial, radial and ulnar arteries). A VF purposely created in children to increase extremity bone length have not caused cardiac failure [12].…”

Section: Discussionmentioning

confidence: 98%

Plethysmographic Forearm Blood Flow Studies in Maintenance Hemodialysis Patients with Radial Arteriovenous Fistulae

Hurwich¹

1969

Nephron

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Bilateral forearm blood flow was measured in 12 patients with radial AVF undergoing maintenance hemodialysis by venipuncture technique. Standard water plethysmographic methods were used. Hand circulation was not occluded by a wrist cuff as this would decrease or stop flow through the AVF. Studies were performed 2 to 36 (mean 18) months after creation of the AVF, and repeated a year later in four patients. Mean gross forearm blood flow with the AVF was 242 ml/min (SD 41.8; SE 10.5); control (opposite arm) mean flow was 21.1 ml/ min (SD 7.9; SE 2.0). Mean AVF flow was 36.1 ml/min/100 ml forearm tissue (SD 14.7; SE 3.7); control mean was 3.5 ml/min/100 ml forearm tissue (SD 1.4; SE 0.4). Mean AVF/control blood flow ratio was 11.5/1.0 (SD 5.5; SE 1.4). After one year intervals flow increased in two patients, was unchanged in one and decreased in one. Mean AVF forearm volume was 13.2% (SE 1.6) greater than control. Blood flow with the AVF is similar to that reported with the external teflonsilastic arteriovenous shunt. It is not an excessive burden on cardiac function.

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“…The sequence of pathophysiological mechanisms that produce local and systemic complications in large volume AVF was well documented by Holman nearly 40 years ago 1 . However, the conclusion that ‘The heart and blood vessels place themselves in harmony with the volume flow of blood through them, the heart by dilatation and hypertrophy, the vessels by dilatation’, seems too optimistic considering that such ‘harmony’ does not always result in total reversal of changes 3,6,7 . Therefore, in all cases of non‐primary heart disease followed by cardiac overload or insufficiency, a physician should insist on data about past injury and consider the possible existence of high‐volume AVF.…”

Section: Discussionmentioning

confidence: 99%

“…1) which might lead to cardiac failure 1 . Over the years, these changes are not totally reversible after closure of the AVF, with a possible unfavourable outcome 2,3 . Adequate diagnosis and treatment is essential in preventing complications, including saving the life of the patient.…”

Section: Introductionmentioning

confidence: 99%

Heart insufficiency in traumatic arteriovenous fistulas

Ilijevski¹,

Otašević

Milosavljevic

et al. 2007

Surgical Practice

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Objective: To analyse the incidence, clinical presentation, and outcome of heart insufficiency in patients with chronic arteriovenous fistulas (AVF). Methodology: From 1991 to 2000 we treated 49 patients with traumatic AVF. The present study included 19 patients with AVF present for 6 months or longer, as it was presumed that these AVF will have an impact on cardiac overload. There were 16 male and three female patients with a mean age of 36 years (17-59). The time from injury to admission varied from 6 months to 33 years. Cardiological examination checked for dyspnoea and palpitation. ECG, chest X-ray and ECHO-cardiography were also performed. All AVF were deleted, magistral vessels reconstructed, non-magistral obliterated, either surgically or by percutaneous embolization. Results: Mean follow up was 44.2 months (3-93). Serious heart insufficiency was seen in two patients only, with AVF in the subclavial vessels. Both suffered from serious heart disease prior to the therapeutic procedures that resulted in iatrogenic AVF, so it was difficult to connect heart insufficiency to the AVF alone. Despite surgical closure of AVF and intensive medical treatment, signs of heart insufficiency remained in both patients. Signs of cardiac overload were seen in six patients with long-standing AVF in major vessels. Except for one patient who refused surgical closure of femoral AVF, the remaining five were symptom free for cardiac overload during the follow-up period. Conclusion: In our series, heart insufficiency was an infrequent complication in long-standing AVF, even when major vessels were involved.

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Cardiac Failure Following Traumatic Arteriovenous Fistula: A Report of Fourteen Cases

Cited by 21 publications

References 0 publications

Perioperative management of biventricular failure after closure of a long-standing massive arteriovenous fistula

Perioperative management of biventricular failure after closure of a long-standing massive arteriovenous fistula

Plethysmographic Forearm Blood Flow Studies in Maintenance Hemodialysis Patients with Radial Arteriovenous Fistulae

Heart insufficiency in traumatic arteriovenous fistulas

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