Heart Failure Due to an Arteriovenous Fistula for Hæmodialysis

A patient developed progressive heart failure three years after creation of a Brescia-Cimino arteriovenous fistula between his radial artery and cephalic vein for hæmodialysis. His jugular venous pressure was elevated 14 cm and he had gross cardiomegaly with a gallop rhythm despite maximal dehydration and good control of hypertension and anæmia. The vessels of his fistula arm were dilated and pulsatile, and occlusion of these reduced his cardiac output from 12.3 to 6.3 litres per minute. Excision of the fistula produced prompt symptomatic improvement with gradual decrease in the cardiomegaly and resolution of the failure. It is concluded that the arteriovenous fistula can be an important and remediable cause of refractory cardiac failure in hæmodialysis patients.