Cardiac complications of arteriovenous access: a narrative review from a multidisciplinary team perspective

Area of Science:

• Nephrology
• Cardiology
• Vascular Surgery

Background:

• Cardiovascular disease is prevalent in hemodialysis patients.
• Arteriovenous access creation, particularly arteriovenous fistulas (AVFs), is linked to cardiac complications.
• These cardiac effects are often subclinical but detectable via echocardiography.

Purpose of the Study:

• To review the pathophysiology of cardiovascular complications associated with AVF creation.
• To discuss different types of cardiovascular complications and their management.
• To explore flow-restrictive procedures for high-flow AVFs and precautions for high-risk patients.

Main Methods:

• Comprehensive review of existing English literature on AVF and cardiovascular complications.
• Analysis of the pathophysiology linking AVF flow dynamics to cardiac strain.
• Evaluation of flow-restrictive procedures and AVF creation strategies.

Main Results:

• Arteriovenous fistulas cause increased venous outflow, potentially leading to cardiac strain.
• Cardiac impact depends on the balance between AVF flow volume and patient cardiac reserve.
• While often well-tolerated, AVFs can precipitate or worsen cardiovascular disease in susceptible patients.

Conclusions:

• AVF creation requires careful consideration of cardiac implications in hemodialysis patients.
• Management strategies include understanding AVF hemodynamics and employing flow-restrictive measures when necessary.
• Optimizing AVF creation and management can mitigate cardiovascular risks in this population.