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Case report
High-output cardiac failure secondary to high-output arteriovenous fistula: investigations, management and definitive treatment
  1. James Leon Hartley1,
  2. Asheesh Sharma2,
  3. Lamis Taha2 and
  4. Thomas Hestletine3
  1. 1Nephrology, Royal Liverpool University Hospital, Liverpool, UK
  2. 2Nephrology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
  3. 3Cardiology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
  1. Correspondence to Dr James Leon Hartley; james.hartley{at}


A 32 year-old woman was admitted to our institution with progressive dyspnoea. Her medical history was notable for end-stage renal failure secondary to chronic pyelonephritis, and she had undergone a cadaveric renal transplant in 2010. This had been preceded by haemodialysis treatment via a radiocephalic arteriovenous fistula. Her diagnostic evaluation was remarkable for pulmonary hypertension. A subsequent doppler ultrasound of her arteriovenous fistula revealed a blood flow of 3 L/min. This is consistent with a high output fistula. Echocardiography demonstrated an improvement in pulmonary artery pressure with occlusion of the fistula. After multidisciplinary discussion, a decision was made to surgically tie off her fistula. The patient experienced immediate improvement in her shortness of breath along with resolution of pulmonary hypertension on echocardiography. This case highlights the rare complication of high output cardiac failure from a dialysis fistula and its successful surgical management.

  • chronic renal failure
  • dialysis
  • renal intervention

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  • Contributors JLH collated the case sequence of events, organised and finalised the case report manuscript for submission. AS provided expert nephrology opinion for the case and helped with literature review and editing of final manuscript. LT consented the patient and prepared the literature review. TH provided expert cardiology opinion on the echocardiographic findings.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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