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< Vol. 13 Issue 4 | Oct-Dec 2012 | pp. 409 - 547

Should functioning AV fistulas be ligated after renal transplantation?

Should functioning AV fistulas be ligated after renal transplantation?

J Vasc Access 2012; 13(4): 405 - 408

Article Type: REVIEW

DOI:10.5301/jva.5000086

Authors

Hillary C. Yaffe, Stuart M. Greenstein

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.

Article History

  • • Accepted on 01/06/2012
  • • Available online on 16/07/2012
  • • Published in print on 16/01/2013

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Authors

  • Yaffe, Hillary C. [PubMed] [Google Scholar]
    Abdominal Organ Transplant Service, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY - USA
  • Greenstein, Stuart M. [PubMed] [Google Scholar]
    Abdominal Organ Transplant Service, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY - USA

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