title: To close or not to close: fistula ligation and cardiac function in kidney allograft recipients.
abstract: BACKGROUND
  Arteriovenous fistulas are a preferred access for hemodialysis. Subsequent hemodynamic changes in systemic circulation may cause heart failure. The general conclusions that can be drawn from the few available studies are that high‑flow fistulas causing symptomatic heart failure should be subjected either to reconstruction or ligation. However, it is still unclear whether a well‑functioning fistula should be ligated after successful kidney transplantation.
  
  
  OBJECTIVE
  The aim of our study was to assess the effect of the fistula on heart function in patients after kidney transplantation.
  
  
  METHODS
  The study included 18 patients after kidney transplantation. Five patients underwent fistula ligation for esthetic reasons; 4 fistulas thrombosed shortly after transplantation. A group of 9 patients with a patent fistula was matched for age and sex. Heart function was assessed by physical examination and echocardiography.
  
  
  RESULTS
  The study group consisted of 6 women and 3 men, aged 32 to 64 years, with 6 forearm and 3 arm fistulas, and with hemoglobin levels ranging from 6.95 to 9.63 mmol/l. The control group consisted of 6 women and 3 men, aged 38 to 66 years, with 5 forearm fistulas and  hemoglobin levels ranging from 7.32 to 9.25 mmol/l. Control echocardiography was performed in each patient 3 months after fistula closure and did not reveal any significant differences compared with baseline examination.
  
  
  CONCLUSIONS
  Fistula ligation performed in a stable kidney allograft recipient does not seem to have a beneficial effect on cardiac function during short-term follow-up. Decision making should be cautious and balanced, because the creation of a new access may be extremely difficult and not always feasible.
authors: Department of Vascular Surgery and Transplantology, Medical University of Bialystok, Białystok, Poland. jerzy.glowinski@wp.pl
authors: Jerzy
authors: J
authors: Głowiński
authors: Jolanta
authors: J
authors: Małyszko
authors: Irena
authors: I
authors: Głowińska
authors: Michał
authors: M
authors: Myśliwiec
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply / Q000601:surgery*; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation; D008026:Ligation; D008297:Male; D009200:Myocardial Contraction; D017534:Radial Artery / Q000601:surgery*; D051437:Renal Insufficiency / Q000628:therapy; D013318:Stroke Volume; D055815:Young Adult