title: The impact of arteriovenous fistula creation in pulmonary hypertension: measurement of pulmonary pressures by right heart catheterization in a patient with respiratory failure following arteriovenous fistula creation.
abstract: Pulmonary hypertension (PHT) is frequent in patients receiving hemodialysis (HD) and carries a high mortality. While it has been suggested that arteriovenous fistulae (AVF) may exacerbate PHT in HD patients, it has also been observed that creating AVF in patients with chronic lung disease and normal renal function may lead to improved exercise tolerance. Most of the observations regarding HD patients using echocardiography demonstrated that temporary closure of AVF improved pulmonary pressures. We present the case of a 45-year-old patient with chronic obstructive pulmonary disease on HD who experienced respiratory failure following AVF formation and underwent right heart catheterization. Severe PHT was diagnosed but transient occlusion of the fistula failed to improve the PHT. This case supports the theory that fistula creation does not exacerbate pre-existing PHT and that AVF can be the access of choice in patients with known chronic lung disease and pulmonary hypertension.
authors.affiliation: Renal and Transplantation Unit, St. George's Hospital NHS Trust, London, UK. dempoulikakos@hotmail.com
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Poulikakos
authors.forename: Davinder
authors.initials: D
authors.lastname: Theti
authors.forename: Vasanti
authors.initials: V
authors.lastname: Pau
authors.forename: Debasish
authors.initials: D
authors.lastname: Banerjee
authors.forename: Daniel
authors.initials: D
authors.lastname: Jones
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography