ASDIN: High‐Output Cardiac Failure Following Insertion of Right Femoral Artery to Left Femoral Vein PTFE Graft for Haemodialysis: A Case Report

Abstract

Arteriovenous grafts used for hemodialysis can produce high-output cardiac failure as a result of shunting of blood through the dialysis access. The following case demonstrates that the problem can occur shortly after graft formation and improved with graft ligation. It caused haemodynamic compromise because of previously undiagnosed, underlying valvular heart disease. It also caused a diagnostic difficulty in the immediate postoperative period as it was mistaken for postsurgical hemorrhage.

Incidence of arteriovenous fistula closure due to high‐output cardiac failure in kidney‐transplanted patients

“…In several case reports, however, high‐flow fistulas are defined with access blood flows (Qa) more than 2000 mL/min and Qa/Co ratios greater than 30–35% . Several reports describe that large AV fistulas can cause high‐output cardiac failure, ventricular hypertrophy, left ventricular (LV) dilatation, elevated LV diastolic filling pressure, structural and functional cardiac changes, secondary pulmonary hypertension, cardiomegaly, arterial stiffness augmentation, distal ischemia, and aneurysm formation . Presently, it is not proven whether these changes only occur in patients with underlying cardiac disease or whether all patients with native AV fistulas are at risk .…”

Development of hyperacute high-output heart failure at access creation

“…There are rare reports of the development of high output heart failure in the days following access creation in the literature. 8,9 To our knowledge, however, these are the first reports of the development of hyperacute heart failure in the operating room at the time of access creation.…”

“…1,[3][4][5][6][7] However, more acute changes of heart failure related to access are only rarely described. 8,9 Here, we present two cases of patients developing what we have termed 'hyperacute' high output heart failure in the operating room immediately following access creation. Permission was granted by the living patient and the family of the deceased patient for publication of case details.…”

Arteriovenous Access

“…The contribution of the fistula to heart failure is likely underrecognized. There are case reports of high-output cardiac failure caused by high-flow grafts, 33 but prospective controlled studies of the contribution of AV access to cardiac geometric changes and clinical outcomes are lacking.…”