Acute Renal Failure and Volume Overload Syndrome Secondary to a Femorofemoral Arteriovenous Fistula Angioplasty in a Kidney Transplant Recipient

Experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation after transplantation modifies hemodynamic parameters and kidney function. We report a case of a renal transplant recipient who developed an acute congestive heart failure accompanied by renal failure, which were triggered by femorofemoral AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. This paper illustrates the potential deleterious consequences of high-output AVF after kidney transplantation and raises considerations regarding the impact of the fistula on cardiac status and kidney function after kidney transplantation and, consequently, the management AVF after transplantation. 1. Introduction Arteriovenous fistula (AVF) is the preferred access for hemodialysis, because of its longevity and resistance to infections [1]. However, large left-to-right shunts generate hemodynamic disturbances that may be deleterious for the cardiovascular system [2]. AVF induces a drop in peripheral vascular resistance, which leads to a compensatory increase in cardiac output. Sympathetic nervous system is activated, leading to an increasing pulse rate, stroke volume, and contractility. If high-output cardiac failure is underrecognized during hemodialysis, because of the absence of obvious volume overload, the deleterious cardiovascular effect of AVF can occur after kidney transplantation. However, experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation after transplantation modifies hemodynamic parameters and kidney function. There is no consensus regarding AVF management after kidney transplantation, and fistula are usually ligated according to the patient wishes and if the clinical situation is controlled. Here we report a case of a renal transplant recipient with a femorofemoral AVF who developed an acute congestive heart failure accompanied by renal failure, which were triggered by AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. 2. Case A 51-year-old Caucasian woman was admitted to our department in April 2011 for a third kidney transplantation. Focal segmental glomerulosclerosis (FSGS) has been diagnosed in 1973, and the patient reached end-stage