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June 1977

Coronary Surgery and Hemodialysis-Reply

Author Affiliations

Chapel Hill, NC

Arch Intern Med. 1977;137(6):813. doi:10.1001/archinte.1977.03630180085030

In Reply.—  We agree that the increase in cardiac output that accompanies an AV fistula contributed to this patient's angina. We also believe that efforts to restrict increases in cardiac output do have a role in the treatment of uremic patients with angina.However, we would emphasize that the appropriateness of a given therapy cannot be assessed in the absence of information concerning pathologic changes in the coronary arteries. The natural history of left main coronary artery lesions is so grim that, where feasible, bypass graft surgery is currently the treatment of choice.1

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