Abstract 14561: Elective Arterio-Venous Fistula Ligation Following Successful Renal Transplantation is Associated with Improvements in Cardiac and Vascular Structure and Function: A Cardiovascular MRI Study
Introduction: Renal transplantation provides an increasingly successful means of restoring renal excretory and metabolic function in end-stage renal failure, however cardiovascular risk amongst successful transplant recipients remains markedly higher than the general population. Utilising cardiovascular MRI (CMR), we evaluated the impact of elective surgical ligation of persistently functioning arterio-venous fistulae (AVF) on cardiovascular structure and function.
Methods: Utilising CMR, we assessed measures of cardiac and vascular structure and function immediately prior to, and 6-months following, elective surgical ligation of persistently functioning AVF following successful, stable renal transplantation.
Results: Eighteen (18) patients were evaluated (median age 59-years [IQR 47-65 years], 77.8% male). AVF ligation was associated with a 95% reduction in ipsilateral brachial artery blood flow (1.59±0.69L/minute vs. 0.083±0.05L/minute, p<0.0001) and significant associated reductions in cardiac output (9.6±2.9L/min vs. 8.1±2.3L/min, p=0.004), bi-ventricular chamber dimensions (LVEDV 192±52mL vs. 167±52mL, p=0.013; RVEDV 175±45mL vs. 153±43mL, p=0.006), left ventricular mass (166±56g vs. 149±51g, p=0.0001) and bi-right atrial area (Left Atrial area 29±5cm2 vs. 26±5cm2, p=0.016; Right Atrial area 27±4cm2 vs. 25±3cm2, p=0.016). Left ventricular ejection fraction was unchanged however. AVF ligation was also associated with improvement in endothelium-dependent brachial artery vasodilatation (2.5±6.5% vs. 8.0±5.9%, p=0.0426), however there was no change in aortic distensibility identified (2.6±1.4mmHg-1 vs. 2.6±1.2mmHg-1, p=0.84).
Conclusion: In the context of persistently elevated cardiovascular risk following renal transplantation, AVF ligation is associated with substantial, beneficial cardiovascular remodelling, including reduction in left ventricular mass and endothelial function - both independent risk factors for cardiovascular events. In the absence of clinical necessity, elective AVF ligation may offer a low-risk option for further reducing cardiovascular risk following successful stable renal transplantation.
- © 2011 by American Heart Association, Inc.