Arteriovenous Fistula Post Nephrectomiam: Clinical Aspects and Surgical Repair

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Abstract
Two cases with arteriovenous fistula of the renal vessels, following nephrectomy more than 20 years earlier, were studied by right heart catheterization both before and 6–7 months after excision of the fistula. The shunt flows, measured during general anaesthesia, were 1.6 and 7.8 1/min, respectively. Pre-operative cardiac outputs were 11.1 and 21.1 1/min, respectively, and stroke volumes 174 and 273 ml. Cardiomegaly and signs of congestive heart failure were present in both cases. The surgical treatment resulted in marked improvements, the heart volume in one case being reduced almost to half its pre-operative value. The systemic arterial blood pressures showed no significant changes, whereas the pulmonary arterial pressures fell markedly. The cardiac output in the two cases fell to 5.1 and 2.7 1/min, respectively, and the stroke volume to 70 and 41 ml. The remarkably]low values in the 2nd case can be explained by impaired cardiac filling resulting from distension of the capacitance vessels due to the previous shunt flow. A change in the cardiac filling/stroke volume curve may also have played a role.

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