Abstract
Objective Arteriovenous fistula (AVF) in patients undergoing hemodialysis (HD) may cause coronary
left internal mammary artery (IMA) steal. This phenomenon was demonstrated by few
prospective studies with limited number of patients and case reports. We aimed to
demonstrate with a relatively larger patient population that the AVF may cause ipsilateral
IMA steal.
Methods We included 22 prospective patients undergoing HD who had left IMA to left anterior
descending artery graft and left upper limb AVF. Right IMA was taken as control. Flows
were assessed by using color Doppler ultrasonography.
Results The mean age was 57.8 ± 9 years. Statistically nonsignificant increases in AVF flow
and decreases in left IMA flow were observed during HD compared with pre-HD. Moreover,
fistula localization did not affect median left IMA flows (for peak systolic velocity
[PSV] 43.7 versus 70 cm/s, respectively; p = 0.7, and for end diastolic velocity [EDV] 3.4 versus 6.5 cm/s, respectively; p = 0.7). We have not detected significant difference in left IMA flows during HD (median
values of PSV 58.4 versus 68.4 cm/s, respectively; p = 0.1, and EDV 6.4 versus 4.4 cm/s, respectively; p = 0.08). Only three patients experienced dialysis-induced reduction of ipsilateral
IMA flow that was accompanied by evidence of hypokinesia of the anterior left ventricular
wall without clinical angina.
Conclusions Hemodynamically affected left IMA flow by ipsilateral upper extremity AVF may cause
steal phenomenon. Hemodynamic differences between left and right IMAs in patients
undergoing HD via left wrist and brachial fistulae are limited.
Keywords
hemodialysis - arteriovenous fistula - coronary steal - coronary bypass surgery
