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High-output cardiac failure secondary to arteriovenous fistula: a wide-based literature review

Saad Moughal, Mohamad Bashir, Idhrees Mohammed, Amr Abdelhaliem, Hazem ElSantawy, Haytham Al-Khaffaf

Performing arteriovenous fistula (AVF) has become common among patients requiring hemodialysis. Apart from complications like bleeding, stenosis, infection, and thrombosis, even high-output cardiac failure has been a matter of concern for these patients. Sever risk factors like upper arm AVF with brachial artery anastomosis, male sex, and volume expansion has been identified. The pathophysiology contributing to this disease process is the shunting of blood from the high-resistance arterial system into the lower resistance venous system, increasing the venous return and eventually cardiac failure. It is also believed cardiac failure in AVF is also a reflection of the underlying cardiovascular disease. This is diagnosed using an echocardiogram and cardiac biomarkers (brain natriuretic peptide & atrial natriuretic peptide). AVF ligation has been shown to improve symptoms of cardiac failure at the expense of losing vascular access. Current guidance recommends schematic predialysis planning process with the aim of optimizing the route of dialysis for an individual patient’s unique psychological, medical and wider social implications.