High-Output Heart Failure and Pulmonary Hypertension Caused by Arteriovenous Graft: Diagnosis and Treatment.

BACKGROUND

Surgical arteriovenous (AV) fistulas provide vascular access for hemodialysis in patients with end-stage renal disease, but this low-resistance pathway can lead to high-flow circulation and cardiac decompensation.

CASE SUMMARY: A 42-year-old woman with end-stage renal disease from chronic glomerulonephritis and a failed renal transplant resumed hemodialysis via a 22-year-old left-arm brachiocephalic AV graft. She developed high-output heart failure. We ligated the AV graft and placed a peritoneal dialysis catheter. Hemodynamic parameters were normal 6 months postligation.

DISCUSSION: Treatment of high-output heart failure and pulmonary hypertension via permanent surgical ligation of an AV fistula is complicated. Ligation can improve cardiac function, but studies are not adequately powered to change practice. The risks and benefits of AV fistula ligation or removal must be reviewed carefully.

TAKE-HOME MESSAGE: This case highlights that high-output heart failure is a serious complication of AV access in patients on dialysis, requiring careful diagnosis and multidisciplinary management.