Heart Failure as a Complication of Hemodialysis

Two patients with Brescia-Cimino fistulas had congestive heart failure. The ultrasonic flowmeter was used to measure increasing fistula flow in both patients, and Branham's sign was elicited in one. Surgical revision of the fistulas resulted in clinical improvement. Congestive heart failure may occur as a result of the surgically created arteriovenous fistula. A pronounced fall in pulse rate when the fistula has been occluded and progressive rise in fistula flow as measured by the flowmeter should alert the physician to the need for surgical revision. THE HEMODYNAMIC EFFECTS of systemic arterio-venous fistulas have been reviewed extensively, and such adverse effects as cardiomegaly and congestive heart failure have been recognized (1-5). The sur-gically created arteriovenous fistula, as described by Brescia and associates, has been a major advance in the field of chronic hemodialysis, and its hemody-namic effects have been believed to have no major clinical significance (6). We describe two patients whose arteriovenous fistulas may have contributed significantly to extremely high cardiac outputs and severe heart failure