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November 6, 1967

Postnephrectomy Arteriovenous Fistula: Report of a Case With Unusual Complications

Author Affiliations

From the Department of Medicine, Montefiore Hospital, University of Pittsburgh School of Medicine, Pittsburgh.

JAMA. 1967;202(6):501-505. doi:10.1001/jama.1967.03130190107015

Twenty years after an uncomplicated right nephrectomy for hydronephrosis, a bruit on the right side of the flank, indicative of an acquired arteriovenous fistula, was first recorded. In late 1965 and early 1966, nearly 36 years after the original surgery, this postnephrectomy arteriovenous fistula was associated clinically with suspected bacterial endarteritis, proven concurrent bacterial endocarditis, and intractable congestive heart failure. In March 1966, the fistula was divided successfully. At the time of surgery, flow across the fistula was calculated and found to approximate 40% of the cardiac output. This postnephrectomy arteriovenous fistula is thought to represent the 15th example of this entity as reported in the medical and surgical literature and the first postnephrectomy arteriovenous fistula reported to be associated with bacterial endarteritis and bacterial endocarditis.