Do arteriovenous fistulas increase cardiac risk?

Faull, Randall J.; Rao, Nitesh; Worthley, M.

doi:10.1111/sdi.12687

Cited by 9 publications

(11 citation statements)

References 26 publications

(39 reference statements)

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“…High-output heart failure is a rare but serious complication described in the literature. There is high evidence that a fistula with a high output, such as worsening or inducing left ventricular hypertrophy, can contribute to the high cardiovascular risk factor present in patients with renal insufficiency [27,28]. This complication, which was observed in 0.9% with only one patient in our study, was treated with fistula closure.…”

Section: Discussionmentioning

confidence: 54%

Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages

Güven

Uludağ

2020

Cureus

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Introduction: The main objective of the present study is to investigate the advantages and disadvantages of proximal arteriovenous native fistulas. Hemodialysis is indispensable for patients with end-stage renal disease. For this purpose, arteriovenous fistulas (AVFs) are used. Among the native fistulas, distal radiocephalic AVF is the most preferred. However, brachiocephalic AVF (BCAVF) and brachiobasilic AVF with basilic vein transposition (basilic vein transposition arteriovenous fistula [BVTAVF]) can be used for a long time in dialysis patients whose distal vascular bed is depleted. Methods: This is a retrospective study of 117 AVFs (BCAVF and BVTAVF), in patients with end-stage chronic renal disease, that were opened with a surgical technique (2012-2018). The postoperative two-year patency rates, AVF locations, complications, and the advantages and disadvantages of these fistulas are reviewed and recorded in the light of the literature. Results: The mean age of the patients (52 men and 65 women) was 60.6 ± 13.6 years. The percentages of primary patency rates at 3, 6, 9, 12, and 24 months were 96.6%, 93.1%, 92%, 87.4%, and 82.8% in BCAVF patients, and 96.7%, 93.3%, 90%, 86.7%, and 80% in BVTAVF patients, respectively. The percentages of secondary patency rates at 6, 12, and 24 months were 100%, 93.3%, and 86.7% in BCAVF patients, and 100%, 100% and 87.7% in BVTAVF patients, respectively. Fistula thrombosis was seen as the most common complication. The early complication was bleeding/hematoma. As late complications, we encountered steal syndrome, ischemic pain in the relevant extremity, pseudoaneurysm, and high-output heart failure. Conclusion: Proximal AVFs are preferable fistulas with early maturation and high primary patency rates. We believe that relatively high complications can be avoided by opening fistulas with an appropriate surgical technique.

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Section: Discussionmentioning

confidence: 54%

Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages

Güven

Uludağ

2020

Cureus

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“…AV access ligation after KT is controversial. [1][2][3] Although there are data suggesting that AVF and AVG are associated with long-term cardiac morbidity, 4 surgeons are often hesitant to ligate a functioning AV access due to concerns that it will be needed if the allograft fails. 8 In the current study, we sought to describe trends in AV access ligation after KT.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] AV fistulas (AVF) and AV grafts (AVG) have been associated with significant cardiac morbidity. 4 There is an increase in cardiac output, left ventricular mass, and left ventricular dilatation after AV access creation that can lead to left-sided heart failure. 5 Increased venous return also leads to elevated right ventricle pressures and subsequent pulmonary hypertension, thereby resulting in an elevated risk of right heart failure as well.…”

Section: Date Of Release September 1 2019 Expiration September 30 2020mentioning

confidence: 99%

Practice patterns in arteriovenous fistula ligation among kidney transplant recipients in the United States Renal Data Systems

Hicks

Bae

Pozo

et al. 2019

Journal of Vascular Surgery

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Background: Arteriovenous fistulas (AVF) and grafts (AVG) have been associated with significant cardiac morbidity that often improves after ligation. However, AV access ligation after kidney transplant (KT) is controversial due to concern for potential long-term allograft failure. We investigated US trends in AV access ligation after KT and the association between ligation and allograft failure.Methods: All adult Medicare patients on pretransplant hemodialysis with a functioning AVF or AVG who underwent first-time KT were studied using the United States Renal Data Systems (January 2011 to December 2013). Post-transplant AV access ligation was determined using current procedural terminology codes. The incidence of post-transplant AV access ligation was described, and characteristics for patients undergoing ligation vs no ligation were compared. Kaplan-Meier curves and Cox proportional hazard models were then used to determine the association of AV access ligation with long-term allograft failure and all-cause mortality after accounting for patient characteristics, donor characteristics, and variation in transplant center practices.Results: A total of 16,845 patients with functioning AVF/AVG received a KT during the study period. Of these, 779 (4.6%) underwent post-transplant AV access ligation. The proportion of patients who underwent ligation varied From the

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“…Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline advises the creation and use of autologous arteriovenous fistula (AVF) for hemodialysis , which is mostly created by anastomosis of the brachial artery and the cephalic vein . Although using AVF for hemodialysis effectively reduces the mortality , AVF creation is shown to induce increased cardiac output, blood volume, pulmonary flow, and pressure as well as decreased peripheral resistance . It is well documented that creation of AVF can lead to cardiac hypertrophy , a decrease of cardiac function , an increase of cardiac output, pulmonary pressure and the risk of cardiovascular disease .…”

mentioning

confidence: 99%

Effect of Blood Pump Flow and Arteriovenous Fistula Blood Flow on the Blood Pressure and Cardiac Function in Patients Undergoing Maintenance Hemodialysis

Tang¹,

Zhu²,

Wang³

et al. 2019

Ther Apher Dial

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The effect of blood pump flow rate on the cardiac functions of hemodialysis patients with arteriovenous fistula (AVF) is largely unknown. This study aimed to investigate if blood pump flow rate (Qb) and AVF access flow rate (Qa) can affect the cardiac function of Chinese hemodialysis patients. A total of 72 patients undergoing AVF hemodialysis were included from March 2010 to June 2014 and dichotomized into the high‐ and low‐flow groups using the medians of Qb (220 mL/min) and Qa (1000 mL/min) as the cutoffs. The cardiac function parameters were measured by ultrasound dilution technique within the first (t + 30) and the last (t − 30) 30 min of dialysis. At t + 30, Qb‐high group had significantly higher systolic blood pressure (SBP) and mean arterial pressure (MAP) than Qb‐low group. At t − 30, Qb‐high group had higher SBP, diastolic blood pressure (DBP), and MAP than Qb‐low group. Qa‐high group had higher SBP, MAP, cardiac output (CO), cardiac index (CI), central blood volume (CBV), and lower peripheral resistance than Qa‐low group. Multiple linear regression showed that at t − 30, Qb was positively correlated with SBP and MAP. Qa was positively correlated with CO, CI, CBV, and PR but negatively correlated with heart rate. Although Qb > 220 mL/min and Qa >1000 mL/min would elevate some parameters, the means of SBP, DBP, MAP remain within the normal range, indicating that appropriate increase in blood pump flow rate has little effect on the cardiac function of hemodialysis patients.

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Do arteriovenous fistulas increase cardiac risk?

Cited by 9 publications

References 26 publications

Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages

Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages

Practice patterns in arteriovenous fistula ligation among kidney transplant recipients in the United States Renal Data Systems

Effect of Blood Pump Flow and Arteriovenous Fistula Blood Flow on the Blood Pressure and Cardiac Function in Patients Undergoing Maintenance Hemodialysis

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