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Cardiac Decompensation after Dilatation of an Arteriovenous Fistula Stenosis: A Case Report

Open Journal of Nephrology 2022年第4期12卷 369-374页

作者： Modou Ndongo Sid Ali Toufik Benyaghla fabrice tiako Mamadou Mouctar Diallo Misylias Bouaoud Houyem Attia Fatiha Lahouel Djillali Ziane Berroudja Nestor Nankeu Tayeb Bensalem Catherine Albert Department of Nephrology Dialysis and Kidney Transplantation of Aristide Le Dantec hospital Dakar Senegal Department of Nephrology Dialysis of Louis Pasteur Hospital Chartres France

The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.

关键词： Arteriovenous Fistula Stenosis Hyperflow Hemodialysis Cardiotoxic

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Calcific Uremic Arteriolopathy or Calciphylaxis in a Hemodialysis Patient: Case Study and Review of the Literature

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Open Journal of Nephrology 2022年第3期12卷 303-310页

作者： Modou Ndongo Nestor Nankeu Josephine Nkok Helene Messet fabrice tiako Mamadou Mouctar Diallo Misylias Bouaoud Attia Houyem Fatiha Lahouel Djillali Ziane Berroudja Tayeb Bensalem Sid Ali Toufik Benyaghla Catherine Albert Sidy Mohamed Seck El Hadji Fary Ka Department of Nephrology Dialysis and Kidney Transplantation of Aristide Le Dantec Hospital Dakar Senegal Department of Nephrology Dialysis of Louis Pasteur Hospital Chartres France Department of Nephrology Dialysis of Ouakam Military Hospital Dakar Senegal

Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hyperalgesic ischemic skin lesions. Several risk factors have been identified, mainly warfarin treatment, mineral and bone disorders (MBD), inflammation and malnutrition. In the evocative forms, the diagnosis is made based upon the physical examination finding of classic painful ulcerated lesions that are covered by a black eschar. Skin biopsy, due to the risk of aggravation and delayed healing, is only performed in case of doubt diagnosis. The therapeutic attitude due to the lack of solid randomized studies is based on expert consensus and requires a multidisciplinary approach. We report here the case of a patient with CUA revealed in the form of multiple ulcerative-necrotic skin lesions associated with pressure sores and arterial wounds.

关键词： Calcific Uremic Arteriolopathy Calciphylaxis Hemodialysis

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