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December 12, 1977

Renal and Cardiac Failure: Complications of an Arteriovenous Fistula in a Renal Transplant Recipient

JAMA. 1977;238(24):2636. doi:10.1001/jama.1977.03280250062028

SINCE THE original description by Brescia et al1 in 1966, arteriovenous fistulas have become the vascular access route of choice for patients undergoing hemodialysis. There are few complications attributable to these fistulas. To our knowledge, this is a previously unreported complication of prerenal azotemia associated with high-output cardiac failure, secondary to an arteriovenous fistula that occurred in a recipient of a renal allograft.

Report of a Case  A 20-year-old man was admitted to the University of California Hospital at San Francisco seven weeks after an uncomplicated cadaver renal transplant. The patient's complaints included progressive leg edema, a 4.6 kg weight-gain, increasing abdominal girth, and progressive dyspnea on exertion, with a greatly decreased exercise tolerance. Prior to transplantation, he had had no history of cardiac symptoms. The patient had two functioning arteriovenous fistulas: a right arm side-to-side distal radial artery-cephalic vein fistula, and a left upper forearm side-to-side brachial artery-anticubital