TITLE:
Cardiac Decompensation after Dilatation of an Arteriovenous Fistula Stenosis: A Case Report
AUTHORS:
Modou Ndongo, Sid Ali Toufik Benyaghla, Fabrice Tiako, Mamadou Mouctar Diallo, Misylias Bouaoud, Houyem Attia, Fatiha Lahouel, Djillali Ziane Berroudja, Nestor Nankeu, Tayeb Bensalem, Catherine Albert
KEYWORDS:
Arteriovenous Fistula Stenosis, Hyperflow, Hemodialysis, Cardiotoxic
JOURNAL NAME:
Open Journal of Nephrology,
Vol.12 No.4,
November
7,
2022
ABSTRACT: The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.