Coronary steal from a left internal mammary artery coronary bypass graft by a left upper extremity arteriovenous hemodialysis fistula.

Journal Article (Journal Article)

In patients with end-stage renal disease undergoing hemodialysis, the upper extremity arteriovenous (AV) fistula is the dialysis access recommended by the DOQI guidelines for patients with appropriate vasculature. Upper extremity AV fistulae have long periods of usefulness, high flow rates, and low associated complication rates. Placement of AV access may result in increased cardiac output and increased cardiac oxygen demand in these patients. In general, cardiovascular complications from AV access have been limited. We report a novel cardiovascular complication of AV access in an end-stage renal disease patient with a coronary artery bypass graft employing the left internal mammary artery who experienced angina while undergoing hemodialysis. The angina was mediated at least in part by cardiac catheterization laboratory-documented steal of blood flow from the internal mammary artery graft. This phenomenon suggests the need to consider the impact of upper extremity access placement on blood flow to the left internal mammary artery in patients who previously have undergone placement of a coronary artery bypass graft.

Full Text

Duke Authors

Cited Authors

  • Crowley, SD; Butterly, DW; Peter, RH; Schwab, SJ

Published Date

  • October 2002

Published In

Volume / Issue

  • 40 / 4

Start / End Page

  • 852 - 855

PubMed ID

  • 12324924

Electronic International Standard Serial Number (EISSN)

  • 1523-6838

Digital Object Identifier (DOI)

  • 10.1053/ajkd.2002.35701


  • eng

Conference Location

  • United States