Should functioning AV fistulas be ligated after renal transplantation?

Hillary C. Yaffe, Stuart M. Greenstein

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

PURPOSE: There is limited literature available to guide physicians on a course of action when they are approached by renal transplant recipients regarding the status of their vascular accesses. However, this is a frequent topic of discussion with these patients and there should be guidelines available to assist in the decision of whether to maintain or ligate an arteriovenous fistula (AVF) in a successful renal transplant patient. This review intends to present some of the literature, as well as to establish guidelines for management.

METHODS: The medical literature was reviewed and anecdotal information from our clinical experience was collected.

RESULTS: Taking into account 10-year adjusted renal transplant graft survival rates, and the relative paucity of donors, it is possible that a successfully transplanted patient will have to return to dialysis at some point. After review of the literature, the impact of AVF ligation on the transplant patient's cardiac morphology and function is not clear. Patient and graft survival do not appear to be impacted by persistent AVFs. Emergent closure of the AVF might be required in cases of severe venous hypertension, risk of rupture from pseudoaneurysm, significant high output cardiac failure or ischemic hand.

CONCLUSIONS: We recommend that following successful renal transplantation, functioning AVFs should almost never be ligated. Many patients require return to dialysis and the physiologic impact of the patent AVF on these patients does not strongly advocate routine ligation following transplant.

Original languageEnglish (US)
Pages (from-to)405-408
Number of pages4
JournalJournal of Vascular Access
Volume13
Issue number4
DOIs
StatePublished - Oct 1 2012

Fingerprint

Kidney Transplantation
Fistula
Arteriovenous Fistula
Transplants
Graft Survival
Kidney
Ligation
Dialysis
Guidelines
False Aneurysm
Blood Vessels
Rupture
Survival Rate
Heart Failure
Hand
Tissue Donors
Hypertension
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Should functioning AV fistulas be ligated after renal transplantation? / Yaffe, Hillary C.; Greenstein, Stuart M.

In: Journal of Vascular Access, Vol. 13, No. 4, 01.10.2012, p. 405-408.

Research output: Contribution to journalArticle

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