Key result
Dilatation of an arteriovenous fistula stenosis in an 85-year-old female with stable dilated cardiomyopathy triggered acute cardiac decompensation and subsequent death.
Why the study?
Dilatation of an arteriovenous fistula stenosis is indicated for reduced dialysis performance or pre-thrombotic risk, but in patients with heart disease, the risk of cardiac decompensation requires careful evaluation.
Case Report (n=1)
Dilatation of AVF stenosis in elderly patients with underlying heart disease can trigger fatal acute cardiac decompensation, highlighting the need to weigh the benefits of AVF salvage against cardiac risks.
AVF dilatation may precipitate fatal decompensation in cardiomyopathy; this case report leaves open the need for prospective cardiac risk assessment before intervention.
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.
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Ndongo et al. (2022) conducted a case report in Arteriovenous fistula stenosis and dilated cardiomyopathy (n=1). Dilatation of arteriovenous fistula stenosis was evaluated. Dilatation of an arteriovenous fistula stenosis in an 85-year-old female with stable dilated cardiomyopathy triggered acute cardiac decompensation and subsequent death.
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