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Ascitis asociada a fístula arteriovenosa

Michael Kolman¹, Lincoln Kavinsky¹, Jeffrey Soble²

¹Division of Nephrology, Rush University Medical Center, Chicago, Illinois, USA.

Seminars in dialysis

|January 6, 2026

Resumen

La ascitis asociada a diálisis puede ser mal diagnosticada. Un caso de ascitis cardíaca por insuficiencia cardíaca de alto gasto debido a una fístula arteriovenosa destaca la necesidad de reconocer la ascitis asociada a FAV.

Área de la Ciencia:

Nefrología
Cardiología
Cirugía Vascular

Sus antecedentes:

La ascitis asociada a diálisis (DAA) es un diagnóstico de exclusión en la enfermedad renal terminal (ESKD) con mal pronóstico.
La DAA a menudo impide que los pacientes accedan al trasplante de riñón.
La insuficiencia cardíaca de alto gasto (HOHF) puede provocar ascitis, imitando la DAA.

Objetivo del estudio:

Reportar un caso de ascitis cardíaca mal diagnosticada como DAA.
Introducir el término ascitis asociada a FAV (AFAA) para la ascitis causada por complicaciones de fístula arteriovenosa.
Enfatizar la importancia de considerar las complicaciones cardíacas de las fístulas arteriovenosas en pacientes en hemodiálisis.

Principales métodos:

Reporte de caso de un paciente con enfermedad renal terminal y ascitis.
Evaluación diagnóstica incluyendo la exclusión de DAA.
Identificación de una fístula arteriovenosa aneurismática como causa de HOHF y ascitis.
Intervención mediante ligadura de FAV.

Principales resultados:

La ascitis del paciente fue inicialmente mal diagnosticada como DAA.
La ascitis se atribuyó correctamente a ascitis cardíaca secundaria a HOHF de una FAV aneurismática.
La ligadura de la FAV condujo a la mejora de HOHF y a la resolución completa de la ascitis.
El paciente se volvió elegible para el trasplante de riñón después de la intervención.

Conclusiones:

La ascitis asociada a FAV (AFAA) es un diagnóstico diferencial crítico para la ascitis en pacientes en hemodiálisis.
Las FAV grandes o aneurismáticas pueden precipitar HOHF y ascitis.
El reconocimiento y manejo tempranos de la AFAA pueden mejorar los resultados del paciente y la elegibilidad para el trasplante.

Palabras clave:

ascitis asociada a fístula arteriovenosa insuficiencia cardíaca de alto gasto ascitis cardíaca diálisis trasplante de riñón

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