Abstract

PIEDRA HERRERA, Blanca Caridad  and  ACOSTA PIEDRA, Yanet. Hemodialysis venous access and chronic impact on cardiovascular system. Rev Cub Med Mil [online]. 2019, vol.48, n.1, e199.  Epub Mar 01, 2019. ISSN 0138-6557.

In the treatment of renal patients in terminal phase. Vascular accesses are used for hemodialysis. They are usually performed in the veins of the upper limbs, especially using Brecia and Cimino technique (lateral arteriovenous fistula of the cephalic and radial at the wrist). The major complication, directly related to an excessive flow of arteriovenous fistula, is congestive heart failure. We present the case of a patient with an arteriovenous (iatrogenic) fistula that caused a congestive heart failure. He is hypertensive and had venous access for over 10 years of evolution (for an apparent diagnosis and for future hemodialysis, which was never performed). He went to the clinic with dyspnea and peripheral edema. Physical examination revealed blood pressure of 160 and 100 mm Hg, clinical signs of cardiomegaly, peripheral edema, jugular engorgement and hepatomegaly. We found a systodiastolic thrill on his left wrist, where there is a scar. A marked dilation and hardening of all the superficial veins of the brachial plexus on that side was observed, that is arterialization of the venous tree of the left upper limb to the superficial veins of hemitorax. The diagnosis was high output heart failure. He improved with the usual treatment, but the acquired venous malformation continued in an iatrogenic manner. It was a very striking case because of the infrequent complication of venous accesses for hemodialysis and because for rarely seen elevated heart failure.

Keywords : arteriovenous fistulas; venous accesses; hemodialysis; high output cardiac failure.

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