Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula.
The arteriovenous (AV) fistula is the access method of choice for long-term hemodialysis according to DOQI guidelines. Among the recognized complications of upper extremity AV fistulae fashioned for hemodialysis are infection, aneurysm formation, and high-output left ventricular failure. We describe a novel cardiopulmonary complication--secondary pulmonary hypertension resulting from an aneurysmal brachiocephalic AV fistula. The clinical presentation, investigation, management, and pathophysiology of this complication are discussed.
Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. mrclarkson@partners.org
Michael Robert
MR
Clarkson
Louise
L
Giblin
Angie
A
Brown
Dillie
D
Little
John
J
Donohoe
D000783:Aneurysm / Q000503:physiopathology / Q000601:surgery; D001164:Arteriovenous Fistula / Q000150:complications* / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods*; D016122:Brachiocephalic Trunk / Q000503:physiopathology / Q000601:surgery*; D016121:Brachiocephalic Veins / Q000503:physiopathology / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000379:methods; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000601:surgery*; D007601:Jugular Veins / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012039:Regional Blood Flow / Q000502:physiology; D006435:Renal Dialysis / Q000379:methods