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Updated: Oct 7, 2025
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Cardiac implications of upper-arm arteriovenous fistulas: A case series
Aidan Pucchio1, Christopher McIntyre2,3, Charmaine Lok4
1School of Medicine, Queen's University, Kingston, ON, Canada.
Insights
Arterio-venous fistulas (AVF) for hemodialysis increase left ventricular mass in end-stage kidney disease patients. Cardiac morphology changes occur within six months, impacting morbidity and mortality risks.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Cardiovascular disease is a significant complication in end-stage kidney disease (ESKD).
- Arterio-venous fistulas (AVF) are standard for hemodialysis vascular access.
- AVF creation impacts cardiac morphology and hemodynamics.
Purpose of the Study:
- To examine cardiac morphology changes after AVF creation in ESKD patients.
- To establish the timeline for these cardiovascular alterations.
- To provide clinical considerations for managing AVF in ESKD.
Main Methods:
- Prospective case series design with patient recruitment before AVF creation.
- Cardiovascular magnetic resonance imaging (CMR) at baseline, 6 months, and 12 months.
- Image segmentation to quantify left ventricular volume/mass, left atrial volume, and ejection fraction.
Main Results:
- All patients showed increased left ventricular mass (mean increase 9.16 g).
- Five patients experienced decreased ejection fraction (mean change -5.4%).
- Cardiac morphology changes were evident by 6-month follow-up.
Conclusions:
- AVF creation leads to increased left ventricular mass in ESKD patients.
- Variability exists in effects on ejection fraction and left atrial volume.
- Further research is needed for optimal vascular access management in ESKD and transplant populations.
Background:
Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage kidney disease. Arterio-venous fistulas (AVF), the gold standard for hemodialysis vascular access, are known to alter cardiac morphology and circulatory hemodynamics. We present a prospective case series of patients after creation of an AVF, explore the timeline for changes in their cardiac morphology, and detail considerations for clinicians.
Methods:
Patients were recruited in 2010 at multiple centers immediately prior to the creation of an upper-arm AVF and the initiation of hemodialysis. Cardiovascular magnetic resonance images were taken at intake before the creation of the AVF, 6-month follow-up, and 12-month follow-up. Image segmentation was used to measure left ventricular volume and mass, left atrial volume, and ejection fraction.
Results:
Eight patients met eligibility criteria. All eight patients had a net increase in left ventricular mass over enrollment, with a mean increase of 9.16 g (+2.96 to +42.66 g). Five participants had a net decrease in ejection fraction, with a mean change in ejection fraction of -5.4% (-21% to +5%). Upon visual inspection the patients with the largest ejection fraction decrease had noticeably hypertrophic and dilated ventricles. Left atrial volume change was varied, decreasing in five participants, while increasing in three participants. Changes in morphology were present at 6-month follow-up, even in patients who did not maintain AVF patency for the entirety of the 6-month period.
Conclusion:
All patients included in this prospective case series had increases in left ventricular mass, with variability in the effects on the ejection fraction and left atrial volume. As left ventricular mass is an independent predictor of morbidity and mortality, further research to determine appropriate vascular access management in both end-stage kidney disease and kidney transplant populations is warranted.
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