Development of high-output heart failure after correction of central venous occlusion: a case report

Flash pulmonary oedema following arteriovenous fistula surgery: rapid assessment and treatment is key to break the vicious cycle

An early adolescent boy with chronic kidney disease on haemodialysis was referred to the surgical clinic for the creation of an arteriovenous fistula. He was undergoing treatment for dilated cardiomyopathy and extrapulmonary tuberculosis. The patient was haemodynamically stable during the procedure, but he developed rapidly progressing dyspnoea, tachycardia and tachypnoea about 10 min after the vessels were declamped. His blood pressure rapidly rose above 220/120 mm Hg and saturation dropped below 90%. A multidisciplinary team (MDT) constituted of surgeons, nephrologists and intensivists was quickly activated. The patient was put on a mechanical ventilator and resuscitated with parenteral antihypertensives, diuretics, amiodarone and haemodialysis. The patient improved clinically and was discharged on the third postoperative day. Thus, a rapidly activated MDT approach was key in breaking the vicious cycle caused by hypertensive crisis, myocardial dysfunction and impending ventilatory failurethat occurred following access surgery.

Flash pulmonary oedema after relief of haemodialysis graft stenosis

Heart failure (HF) and chronic kidney disease (CKD) are undoubtedly very much interrelated, especially in patients with end-stage renal disease (ESRD) who are dependent on renal replacement therapy. Haemodialysis (HD) is of particular interest in cardiovascular patients due to the creation of a haemodialysis vascular access and the haemodynamic changes associated with it. Adequate HD though is very dependent on a properly functioning vascular access. Unfortunately, these surgical vascular accesses are vulnerable to stenoses and occlusions. Percutaneous endovascular treatment of these stenoses is often performed and has been found to be safe and effective. Despite its frequent use, acute medical complications of this percutaneous procedure have not been well-documented. In this report, we describe a patient who developed flash pulmonary oedema after balloon angioplasty treatment of an arteriovenous graft (AVG) stenosis.