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The Cardiovascular Effects of Arteriovenous Fistulas: A Cause for Concern?

Cardiac-1.jpgJennifer MacRae and her colleagues from the University of Calgary, Calgary, Alberta, Canada, reviewed the hemodynamic and cardiovascular consequences of arteriovenous fistulas. Their findings were published in a 2006 paper in Seminars in Dialysis.

MacRae identified three periods when the presence of an AV fistula influences a patient's hemodynamics.

1. Immediate Effects of Creation of an AV Fistula

  • Increase in cardiac output (10-20%)
  • Increase in sympathetic nervous system activity (increasing contractility)
  • Increase in stroke volume and heart rate
  • Decrease in peripheral resistance

2. Hemodynamic Changes Within 1 Week of Creation of an AV Fistula

  • Increase in circulating blood volume
  • Increase in neuro-hormones
  • Decrease in plasma renin and aldosterone levels
  • Decrease in Systemic vascular resistance and systolic/diastolic blood pressure

3. Consequences of Long-Term AV Fistulas

  • Left Ventricular hypertrophy
  • High-Output cardiac failure
  • Exacerbation of coronary ischemia
  • Central vein stenosis

From their analysis, MacRae and her team concluded that:

  • A thorough cardiac assessment should be performed in patients with coronary artery disease before placing an AV fistula.
  • Regular careful evaluations are necessary in patients with cardiac disease and AV fistulas.
  • Patients with a large AV fistula and high flow should be monitored closely.
  • Patients with high flow fistulas (flow greater than 2 L/min) and increasing LVEDV are recommended to have a flow reduction procedure on their AVF.
  • Patients with preexisting severe ischemic heart disease (class III unstable angina) should avoid an AV fistula placement if the underlying ischemia cannot be treated.

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