Acute systemic hypotension after arteriovenous fistula construction in a patient with severe aortic stenosis

We report the case of a 53-year-old hemodialysis patient with severe aortic stenosis, who developed acute systemic hypoperfusion after arteriovenous fistula (AVF) construction. He presented with hypotension and repeated syncope soon after distal radiocephalic AVF construction, and finally developed...

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Bibliographic Details
Published in:Clinical and experimental nephrology 2011-10, Vol.15 (5), p.788-790
Main Authors: Mise, Naobumi, Uchida, Lisa, Tanaka, Mototsugu, Tanaka, Shinji, Nakajima, Hiroyoshi, Sugimoto, Tokuichiro
Format: Article
Language:English
Subjects:
Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Arteriovenous Shunt, Surgical - adverse effects
Cardiac Output
Case Report
Heart Failure - etiology
Heart Valve Prosthesis Implantation
Humans
Hypotension - etiology
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Urology
Vascular Resistance
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Summary:We report the case of a 53-year-old hemodialysis patient with severe aortic stenosis, who developed acute systemic hypoperfusion after arteriovenous fistula (AVF) construction. He presented with hypotension and repeated syncope soon after distal radiocephalic AVF construction, and finally developed a respiratory arrest. His blood pressure and hemodynamics recovered promptly by sub-emergent aortic valve replacement surgery. In the present case, the heart with severe aortic stenosis could not increase cardiac output in response to the reduction in peripheral vascular resistance caused by the AVF. High-output heart failure, a relatively rare AVF-associated disorder, occurs with an excessive AVF flow, usually more than 3 L/min or 30% of cardiac output. However, heart failure may develop soon after construction of an AVF with a moderate blood flow if a patient’s cardiac function is severely impaired. In addition, heart failure may improve with AVF preservation if the underlying heart disease is treatable.
ISSN:1342-1751
1437-7799
DOI:10.1007/s10157-011-0484-3