Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

2020 ◽  
Vol 21 (5) ◽  
pp. 753-759
Author(s):  
Barbara Maresca ◽  
Fausta Barbara Filice ◽  
Sara Orlando ◽  
Giuseppino Massimo Ciavarella ◽  
Jacopo Scrivano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Reduction Rate ◽  
Left Ventricular ◽  
High Flow ◽  
Evaluation Tool ◽  
Artery Ligation ◽  
Flow Reduction ◽  
High Output

Background: Arteriovenous fistula (AVF) for haemodialysis (HD) induces a volume/pressure overload which impairs bi-ventricular function and increases systolic pulmonary arterial pressure (PAPS) and left ventricular mass (LVM). In the presence of high blood flow (Qa) AVF (> 1.5 L/min/1.73 m2) and cardio-pulmonary recirculation (>20%), high-output congestive heart failure (CHF) may occur and AVF flow reduction is recommended. Proximal Radial Artery Ligation (PRAL) is an effective technique for distal radio-cephalic (RC) AVF flow reduction. Methods: we evaluated six HD and four transplant patients with high-flow RC AVF and symptoms of CHF who underwent PRAL. We compared echocardiographic (ECHO) findings before (T0) and 1 and 6 months (T1,T6) after PRAL. Preoperative ECHO was performed before (T0b) and after AVF anastomosis manual compression (T0c). Results: At T1 AVF flow reduction rate was 58.4% ± 13% and 80% of patients reported improved CHF symptoms. ECHO data showed an improvement of tricuspid annular plane systolic excursion (TAPSE) at T1 (p = 0.03) and a reduction of PAPS at T6 (p = 0.04). TAPSE improved after AVF anastomosis compression during preoperative ECHO (p = 0.03). Delta of TAPSE at the dynamic manoeuvre at T0 directly correlated with early (1 month after PRAL, p = 0.01) and late (6 months after PRAL, p = 0.04) deltas of TAPSE. Conclusions: AVF flow reduction after PRAL induces immediate regression of CHF symptoms, early improvement of TAPSE and late improvement of PAPS, suggesting a prevalent right sections involvement in CHF. Preoperative TAPSE modification after AVF anastomosis compression could represent a useful evaluation tool to determine which patients would benefit of PRAL.

Endovascular repair of a traumatic popliteal arteriovenous fistula

VASA ◽  
2006 ◽  
Vol 35 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Papavassiliou ◽  
Dervisis ◽  
Argitis ◽  
Xanthopoulos ◽  
Loupou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Lower Limb ◽  
High Flow ◽  
Delay In Diagnosis ◽  
High Output Heart Failure ◽  
Long Term Follow Up ◽  
High Output

We report a case of an arteriovenous fistula (AVF) following osteosynthetic treatment of a fracture of the lower limb 13 years ago. A stent-graft technique had been used to close a high flow traumatic AVF between the popliteal artery and the popliteal vein. The failure to properly evaluate traumatic AVF may sometimes lead to remarkable delay in diagnosis with devastating consequences including edema, ischaemia, ulceration and high output heart failure. Endovascular treatment of these lesions is promising but long-term follow-up will be required to determine the durable patency and the onset of potential complications.

scholarly journals A case report: percutaneous management of high-output heart failure from iatrogenic aortocoronary venous grafting to the coronary sinus

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Akarsh Parekh ◽  
Vivek Sengupta ◽  
Ryan Malek ◽  
Mark Zainea
Keyword(s):  
Heart Failure ◽  
Coronary Sinus ◽  
Saphenous Vein Graft ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Covered Stents ◽  
Bypass Grafting ◽  
Output State ◽  
State Management ◽  
High Output

Abstract Background Aortocoronary arteriovenous fistula (ACAVF) due to iatrogenic bypass grafting to a cardiac vein is an exceedingly rare complication resulting from coronary artery bypass grafting (CABG) surgery. If not identified in a timely fashion, ACAVF has known significant clinical consequences related to left to right shunting and possible residual myocardial ischemia. Case presentation An 82-year-old male with a history of CABG, presented with dyspnea. Over the span of 2 years following CABG, the patient experienced progressive exertional dyspnea and peripheral edema. The patient was found to have a new cardiomyopathy with a severely reduced ejection fraction at 30–35%. The patient underwent diagnostic left heart catheterization, and an ACAVF was discovered between a saphenous vein graft and the coronary sinus. The patient underwent successful percutaneous coiling of the ACAVF with no residual flow. Follow-up echocardiography at 3 months revealed restoration of left ventricular systolic function to 50% and significant improvement in heart failure symptoms. Conclusions ACAVF is an exceedingly rare iatrogenic complication of CABG that may result in residual ischemia from the non-grafted myocardial territory and other sequelae relating to left to right shunting and a high-output state. Management for this pathology includes but is not limited to the use of percutaneous coiling, implantation of covered stents, graft removal and regrafting, and ligation.

Abstract P237: Is Ischemia/Reperfusion an Efficient Method for Producing Heart Failure in Rats?

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Ana Carolina M Omoto ◽  
Fábio N Gava ◽  
Mauro de Oliveira ◽  
Carlos A Silva ◽  
Rubens Fazan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Pressure ◽  
Histopathological Examination ◽  
Ischemia Reperfusion ◽  
Mitral Annulus ◽  
Mortality Rates ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Coronary Artery Ligation ◽  
Artery Ligation

Myocardium infarction (MI) elicited by coronary artery ligation (CAL) is commonly used to induce chronic heart failure (HF) in rats. However, CAL shows high mortality rates. Given that ischemia-reperfusion (IR) may cause the development of HF, this approach may be useful for obtaining a model of HF with low mortality rates. Therefore, it was compared the model of CAL vs. IR in rats, evaluating the mortality and cardiac morphological and functional aspects. The IR consisted of 30 minutes of cardiac ischemia. Wistar rats were assigned into three groups: CAL: n=18; IR: n=7; SHAM (fictitious IR): n=7. After four weeks of CAL, the subjects were evaluated by echocardiography and ventriculography as well. The statistical analysis consisted of ANOVA combined with Tukey’s posthoc test (p<0.05). There were no deaths in the IR and SHAM groups, whereas in the CAL group the mortality rate was 33.33% (6 out of 18). In the CAL group echocardiography showed increased left ventricular (LV) cavity during systole (8.3 ± 1mm) and diastole (10.5 ± 1mm); decreased LV free wall during systole (1.4 ± 0.5 mm); increased left atrium/aorta (2.3 ± 0.4) ratio. These changes were not significant in IR (4.8 ± 0.5mm, 7.6 ± 0.6mm, 2.6 ± 0.3 mm, 1.6 ± 0.2) and SHAM (4.6 ± 0.6 mm, 7.7 ± 0.8mm, 2.8 ± 0.4mm, 1.5 ± 0.2) groups. There was also the reduction in the ejection fraction in the CAL group (41 ± 12 %) when compared with IR (65 ± 9%) and SHAM (69 ± 7%) groups. The tissue Doppler analysis from the lateral mitral annulus showed reduction in E′ in CAL (-29 ± 8 mm/s) and IR (-31± 9 mm/s) groups when compared with the SHAM (-48 ± 11 mm/s) group. The ventriculography in the CAL group showed smaller maximum dP/dt (6519 ± 1062) and greater end-diastolic pressure (33 ± 8 mmHg) when compared with IR (8716 ± 756 mmHg/s; 9 ± 9 mmHg) and SHAM (7989 ± 1230 mmHg/s; 9 ± 7 mmHg) groups. The CAL group presented transmural infarct size of 40% of the left ventricular wall, measured under histopathological examination. In conclusion, IR for 30 minutes caused only small changes in LV diastolic function, assessed by tissue Doppler; however, the IR was not effective for promoting HF, as observed with CAL. Thus, it is possible that prolonged IR is necessary for promoting significant HF in rats.

Regulation of K+ and Ca2+ channels in experimental cardiac failure

1991 ◽  
Vol 261 (6) ◽  
pp. H1979-H1987 ◽  
Author(s):  
M. Gopalakrishnan ◽  
D. J. Triggle ◽  
A. Rutledge ◽  
Y. W. Kwon ◽  
J. A. Bauer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Cardiac Failure ◽  
Radioligand Binding ◽  
Weight Ratio ◽  
Left Ventricular ◽  
Coronary Artery Ligation ◽  
Artery Ligation ◽  
The Right

To examine the status of ATP-sensitive K+ (K+ATP) channels and 1,4-dihydropyridine-sensitive Ca2+ (Ca2+DHP) channels during experimental cardiac failure, we have measured the radioligand binding properties of [3H]glyburide and [3H]PN 200 110, respectively, in tissue homogenates from the rat cardiac left ventricle, right ventricle, and brain 4 wk after myocardial infarction induced by left coronary artery ligation. The maximal values (Bmax) for [3H]glyburide and [3H]PN 200 110 binding were reduced by 39 and 40%, respectively, in the left ventricle, and these reductions showed a good correlation with the right ventricle-to-body weight ratio in heart-failure rats. The ligand binding affinities were not altered. In the hypertrophied right ventricle, Bmax values for both the ligands were not significantly different when data were normalized to DNA content or right ventricle weights but showed an apparent reduction when normalized to unit protein or tissue weight. Moderate reductions in channel densities were observed also in whole brain homogenates from heart failure rats. Assessment of muscarinic receptors, beta-adrenoceptors and alpha 1-adrenoceptors by [3H]quinuclidinyl benzilate, [3H]dihydroalprenolol, and [3H]prazosin showed reductions in left ventricular muscarinic and beta-adrenoceptor densities but not in alpha 1-adrenoceptor densities, consistent with earlier observations. It is suggested that these changes may in part contribute to the pathology of cardiac failure.

Proximal Radial Artery Ligation after Distalization of a High flow Brachio-Cephalic Fistula. A Novel Approach to Inflow Reduction

2008 ◽  
Vol 9 (4) ◽  
pp. 291-292 ◽  
Author(s):  
J.B. Smith ◽  
F.R. Calder
Keyword(s):  
Radial Artery ◽  
Vascular Access ◽  
High Flow ◽  
Artery Ligation ◽  
Novel Technique ◽  
Novel Approach ◽  
Brachiocephalic Fistula

High flow fistulae present a common challenge to vascular access (VA) surgeons and many strategies have been described, each with their benefits and limitations. There are no NK-DOQI guidelines for the management of high flow fistulae or indeed the management of those refractory to more conventional approaches. We discuss a novel technique to inflow reduction in a previously distalized brachiocephalic fistula and recommend the technique of proximal radial artery ligation.

scholarly journals High Output Heart Failure Associated with Arteriovenous Fistula in the Setting of Kidney Transplant

2020 ◽  
Author(s):  
Rachel S. Chang ◽  
Jiun-Ruey Hu ◽  
Joshua A. Beckman ◽  
Rachel C. Forbes ◽  
Saed Shawar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Kidney Transplant ◽  
High Output Heart Failure ◽  
High Output

scholarly journals Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Mahmoud Tolba ◽  
Martin Maresch ◽  
Dhafer Kamal
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Hemodialysis Patient ◽  
Ulnar Artery ◽  
Complete Relief ◽  
Retrograde Flow ◽  
Palmar Arch ◽  
Artery Ligation ◽  
Steal Syndrome ◽  
Distal Radial Artery

Abstract We present a case of dialysis associated steal syndrome in a hemodialysis patient with left radiocephalic arteriovenous fistula that caused him severe rest pain. Angiography showed retrograde flow from the ulnar artery to the distal radial artery through a hypertrophied palmar arch. The problem was solved by surgical ligation of the distal radial artery leading to complete relief of patient symptoms without any notable complications.

P1336PROPHYLACTIC CLOSING OF AV FISTULA PREVENTS HIGH OUTPUT HEART FAILURE - A SINGLE-CENTER RANDOMISED CONTROLLED TRIAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Patrick Hetz ◽  
Silvana Müller ◽  
Lydia Posch ◽  
Martin Tiefenthaler
Keyword(s):  
Heart Failure ◽  
Intervention Group ◽  
High Flow ◽  
Control Group ◽  
P Value ◽  
Post Transplant ◽  
High Output Heart Failure ◽  
Av Fistulas ◽  
Paired T Test ◽  
High Output

Abstract Background and Aims AV fistulas are the favoured way ensuring a safe long-term access for patients with need for hemodialysis. Various studies, including a prior retrospective trial at our department, showed that AV fistulas are an additional burden on the cardiac-vascular system leading to frequent fistula closure in post-transplant patient. In literature, there is a widespread approach in dealing with high-flow fistulas in post-transplant patients with stable kidney function is reported. Method For this trial, patients with a stable graft function (min. 3 months post-transplant) and a brachial artery flow of min. 1,500 ml/min were recruited. Initially planned for multi-centric analysis, 28 patients were randomised in Innsbruck. Exclusion criteria were a pre-existing cardiac failure with ejection fraction less than 25%, NT-pro-BNP &gt; 1,400 ng/l and NYHA score ≥ III. These patients were randomised in a 1:1 ratio in intervention group with immediate fistula ligature after randomisation, and control group with no surgical intervention. Patients in the control group had fistula ligature only if at least two criteria for ligature occurred. These criteria were selected in agreement with of the department for cardiology and encompassed dilation of right atrium, of inferior vena cava or of pulmonary artery, left-ventricular eccentricity index &lt; 1 or a systolic pulmonary artery pressure of &gt; 35 mmHg. The main endpoint high-output heart failure was defined by min. 2 echocardiographic criteria and signs of congestive heart failure such as worsening in NYHA score. A follow-up procedure of 24 months with quarterly measurements of kidney function, NT-proBNP and lactat dehydrogenase as well as a biannual echocardiographic check-up were performed. Statistics included paired t-test and Wilcoxon-rank test for median/mean comparison and chi-quadrat test for absolute frequency. Results The main endpoint high-output heart failure referable to high fistula flow was reached in five of 13 control patients (38.5%), whereas in the intervention group no study patient showed a worsening in clinical and echocardiographic signs to reach criteria for ligature. Prophylactic ligature of high-flow fistulas avoided right heart failure in our patient collective (p-value 0.013, x?test). Three patients had to undergo ligature due to off-study complications such as progressive aneurysma formation and steal phenomenon. One patient with dyspnoe preferred fistula ligature but was not fulfilling echocardiographic criteria. In total nine patients in the control group were assigned to fistula ligature. Matching all conducted fistula closures median NT-proBNP was 317 ng/l pre-ligature and 223 ng/l post-ligature (p 0.003, Wilcoxon). In total, 18 of 21 patients (excluding 2 patients with lack of data) showed falling NT-proBNP values. Creatinine levels showed a decrease from 1.69 mg/l to 1.60 mg/l (p-value 0.059, paired t-test). The intervention group included 14 patients with a gender ratio of 12 men to 2 women and a mean age of 52.5 years; the same age and gender distribution was seen in the control group. Fistula flow per m?body surface did not differ significantly (980 ml/min vs. 1000 ml/min). Echocardiographic findings showed improvement in ligature patients (e.g. a drop of sPAP in 7/8 ligature patients with available data) but did not reach statistical significance. Conclusion A prophylactic ligature of high-flow AV fistulas can avoid high-output heart failure and a more liberal approach to closure AV fistulas may be discussed in future.

Sign in / Sign up

Export Citation Format

Share Document