High-output cardiac failure secondary to a brachiocephalic arteriovenous hemodialysis fistula: two cases.

The use of native arteriovenous fistulas for hemodialysis access is important to the success of this form of treatment for patients with end-stage renal disease. Native fistulas have been shown to provide improved longevity and to have lower complication rates when compared to prosthetic graft fistulas. High-output cardiac failure related to hemodialysis fistulas is an uncommon complication of their usage. Two renal transplant patients who did develop this complication from large well-developed brachiocephalic arteriovenous hemodialysis fistulas are presented. Both patients underwent successful transplantation and have required fistula ligation, with subsequent resolution of their cardiac failure. Native fistulas remain the best choice for hemodialysis access, but the clinician should remain aware of the possible untoward hemodynamic effects of these fistulas.