High-Output Cardiac Failure and Coronary Steal With an Arteriovenous Fistula

Amtul Aala, Sairah Sharif, Leslie Parikh, Paul C. Gordon, Susie L. Hu

Research output: Contribution to journalArticlepeer-review


Creation of an arteriovenous access for hemodialysis can provoke a sequence of events that significantly affects cardiovascular hemodynamics. We present a 78-year-old man with end-stage renal disease and concomitant coronary artery disease previously requiring coronary artery bypass grafting including a left internal mammary graft to the left anterior descending artery, ischemic cardiomyopathy with left ventricular systolic dysfunction, and severe aortic stenosis who developed hypotension unresponsive to medical therapy after recent angioplasty of his ipsilateral arteriovenous fistula for high-grade outflow stenosis. This case highlights the long-term effects of dialysis access on the cardiovascular system, with special emphasis on complications such as high-output cardiac failure and coronary artery steal syndrome. Banding of the arteriovenous fistula provided symptomatic relief with a decrease in cardiac output. Avoidance of arteriovenous access creation on the ipsilateral upper extremity in patients with a left internal mammary artery bypass graft may prevent coronary artery steal syndrome.

Original languageEnglish (US)
Pages (from-to)896-903
Number of pages8
JournalAmerican Journal of Kidney Diseases
Issue number6
StatePublished - Jun 2018
Externally publishedYes


  • Arteriovenous fistula (AVF)
  • aortic stenosis
  • cardiac failure
  • cardiovascular disease
  • coronary artery bypass graft (CABG)
  • coronary steal
  • end-stage renal disease (ESRD)
  • hemodialysis access
  • hemodynamics
  • high-output cardiac failure
  • left internal mammary artery
  • left ventricular systolic dysfunction

ASJC Scopus subject areas

  • Nephrology


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