Long-term Effects of Arteriovenous Fistula Closure on Echocardiographic Functional and Structural Findings in Hemodialysis Patients: A Prospective Study

Movilli, Ezio; Viola, Battista Fabio; Brunori, Giuliano; Gaggia, Paola; Camerini, Corrado; Zubani, Roberto; Berlinghieri, Nicola; Cancarini, Giovanni

doi:10.1053/j.ajkd.2009.11.008

Cited by 71 publications

(51 citation statements)

References 15 publications

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“…We have observed dramatic clinical and echocardiographic resolution of severe, symptomatic CHF in 3 patients following AVF closure and permcath placement. In a recent paper [30], 25 HD patients with malfunctioning AVF who underwent fistula closure and permcath insertion were compared with 36 matched controls with functioning AVF. The closure group had significant decreases in LV mass, LV mass index, LV diastolic diameter, septal thickness, diastolic posterior wall thickness, and significant increases in EF, compared with no significant changes in the control group.…”

Section: Reversal Of Avf Toxicitymentioning

confidence: 99%

Arteriovenous Fistula Toxicity

et al. 2011

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The arteriovenous fistula (AVF) has been a mainstay of hemodialysis treatments and the preferred access route since its inception in the 1960s, due to its longevity and resistance to infection. However, the AVF is not benign. There is significant primary failure, as well as cardiac, vascular, and other, less well recognized, complications. Together, they represent toxicity, to which considerable morbidity and mortality can be attached. Official policy, based on guidelines where AVF toxicity is given short shrift, drives an increase in use of these devices, and may have undesired consequences.

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Section: Reversal Of Avf Toxicitymentioning

confidence: 99%

Arteriovenous Fistula Toxicity

et al. 2011

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“…Awareness of this condition in ESRD patients is important as the vasodilatory effects of current standard neurohormonal antagonists may cause deterioration of hypotension. Additionally, interventions to reduce the vascular access blood flow, including banding of the AV fistula or revision using a distal inflow technique, can be effective in some patients with high-flow AV fistula by improving cardiac structure and hemodynamics (45, 46) and thereby reversing heart failure symptoms (47) . However particular attention should be taken when considering AV access closure in patients with severe heart failure.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations

Chirakarnjanakorn

Navaneethan

Francis

et al. 2017

International Journal of Cardiology

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Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology, cardiovascular mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the cardiovascular system. There are many cardiovascular changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the cardiovascular system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause cardiovascular dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may improve the poor quality of life and high mortality rate that these patients experience.

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“…There are also multiple studies showing that closure of an AVF after renal transplantation results in favorable cardiac remodeling and a reduction in LVH. [31][32][33][34] In animal models, Liu et al 35 demonstrated an adaptive effect on LV mass and myocyte function and morphology with time: the initial volume overloading from a large aortocaval fistula was characterized by depressed LV function and compensatory hypertrophy resolving to normal cardiac function at 1-month postfistula formation. 36 Further research is clearly required to clarify the relationship between AVF with the ROX Coupler and LVH.…”

Section: Holmanmentioning

confidence: 99%