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High-Output AV Fistula — ESENeph MCQ

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ModerateHaemodialysisHigh-Output AV FistulaESENeph

A 56-year-old man on haemodialysis develops a high-output AV fistula with a flow rate of 2800 mL/min measured on ultrasound. He has new-onset heart failure symptoms (dyspnoea, peripheral oedema) and echocardiography shows a high-output state with LV dilatation. What is the most appropriate management?

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Correct answer: B — Surgical banding or flow reduction of the fistula

High-flow AV fistulae (typically >1500-2000 mL/min) can cause high-output cardiac failure. UKKA vascular access guidelines recommend surgical intervention (banding, plication, or revision) to reduce fistula flow while preserving access function. The target is to reduce flow to below 1500 mL/min while maintaining adequate dialysis. Complete ligation would remove the patient's dialysis access unnecessarily. Medical heart failure management is adjunctive but does not address the cause.

Reference: UK Kidney Association 2019 – Vascular Access; ERA-EDTA 2019 – Vascular Access