Arteriovenous Fistula Creation for End-Stage Renal Disease May Worsen Pulmonary Hypertension.

Pulmonary hypertension (PH) is an increase in pulmonary arterial pressure secondary to narrowing and obliteration of the lumen of the lung vessels resulting in an increased resistance to flow. It is defined by a mean pulmonary arterial pressure (mPAP) ≥25 mm Hg at rest usually confirmed by right heart catheterization compared with normal mPAP of ≤20 mm Hg. The primary etiology of PH is unclear, although it can be from the heart, lung, or systemic disease. Patients with end-stage renal disease (ESRD) are at increased risk of developing PH, with up to 39% of patients with an arteriovenous fistula (AVF) developing PH. Multiple physiologic factors contribute to or exacerbate the PH in ESRD patients, including volume overload, increased vascular tone, and underlying heart failure. An additional contributing factor for PH is the AVF itself, which results in increased pulmonary flow and pressure. In this study, we report 2 patients with ESRD who clinically declined after the creation of an AVF or graft and required ligation of their AVF due to the development of high-output heart failure and progressive PH in the early postoperative period.