Perioperative Considerations for Emergent Arteriovenous Fistula Ligation in a Post-Cardiac Arrest Patient with High Output Heart Failure

In patients undergoing hemodialysis, surgically created arteriovenous fistulas (AVFs) are the preferred option for vascular access. However, an often overlookedcomplication of AVFs is the development of high-output heart failure (HOHF). When a substantial amount of arterial blood is diverted from the left side to the right side of the circulatory system through the fistula, the resulting increase in preload can lead to elevated cardiac output (CO). Over time, this increased workload on the right heart will cause right ventricular dilation and eventually pulmonary hypertension.1Patients with HOHF typically exhibit symptoms such as tachycardia, elevated pulse pressure, a hyperdynamic precordium, and jugular venous distension. Anesthetic management must avoid myocardial depression and significant afterload reduction to prevent further cardiac strain.