Refractory orthostatic hypotension after creation of a brachio-basilic arteriovenous fistula

Arteriovenous fistulas (AVFs) are preferred vascular access in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). However, AVFs, can occasionally lead to clinically significant complications. Of these, cardiovascular complications have been well described in the literature. In this report, we describe a case of a 78-year-old Caucasian male with ESRD who presented with severe debilitating dizziness and orthostatic hypotension that started soon after the creation of left brachiobasilic AVF. The patient had no significant cardiovascular history apart from essential hypertension. His symptoms persisted despite extensive evaluation and interventions, and abated only after banding of the AVF. This report describes the timeline of the patient's clinical course beginning from the day of creation of his AVF, through the course of his hospitalization leading to AVF banding and ending with postoperative recovery phase with resolution of symptoms. We will also review the pathophysiologic effects of AVF on cardiovascular system, as well as the potential causes of our patient's clinical presentation.