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High-output congestive failure from femoral arteriovenous shunts for vascular access
Insights
High-flow femoral arteriovenous bovine shunts (FAVBS) can cause congestive heart failure. To prevent this, maintain intraoperative graft flow rates below 900 cc/min to avoid complications requiring shunt revision or removal.
Area of Science:
- Vascular Surgery
- Nephrology
- Cardiology
Background:
- Femoral arteriovenous bovine shunts (FAVBS) are utilized for chronic hemodialysis vascular access.
- High flow rates through FAVBS can lead to serious complications.
Observation:
- Four patients developed high-output congestive heart failure (HOCHF) due to excessive FAVBS flow rates.
- This complication necessitated surgical intervention.
Findings:
- Intraoperative graft flow rates exceeding 900 cc/min are associated with HOCHF.
- HOCHF secondary to FAVBS can be resistant to conservative management.
Implications:
- Monitoring and controlling intraoperative graft flow rates are crucial for preventing HOCHF.
- Shunt banding or removal may be required for refractory HOCHF cases.
- This highlights the importance of careful management of FAVBS to ensure patient safety and treatment efficacy.
Abstract:
Femoral arteriovenous bovine shunts (FAVBS) represent an accepted method of vascular access for patients requiring chronic hemodialysis. The authors present 4 patients who required corrective surgery for high-putput congestive heart failure (HOCHF) secondary to high flow rates through the shunt. In order to avoid this serious complication, intraoperative graft flow rates should not exceed 900 cc/min. HOCHF secondary to FAVBS may be refractory to conservative therapy and require either banding of the shunt or its removal.