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Clinical impact of previous CABG history on AV access creation
Posted By Hyungseok Lee, Friday, April 8, 2022
Updated: Friday, April 8, 2022

A hemodialysis patient with a history of CABG (coronary artery bypass graft) operation visited my center for arteriovenous access creation.

This patient had undergone multiple AV access placements on his right arm. When I examined the current AV graft of his right upper arm, it was found to end its longevity, and no more AV access placement was feasible on his right arm. In contrast, he had never had vascular access surgery on his left arm because his physician emphasized that any AV access should not be placed on his left arm to avoid coronary steal syndrome. In fact, the patient underwent CABG using the left internal thoracic artery. I'd like to recommend a new AV access creation in the left arm, but the patient is afraid that he will die of AMI if he gets AV access in his left arm. So, I'm here to ask you for advice.

First,

Would it lead to coronary steal syndrome if I created an AVF or AVG on his left arm? How high is the probability for the patient to encounter a coronary steal in such a case?

Second,

If an AVF creation was planned in the left arm, would limiting blood flow, for example, to 600-800ml/min or less help to reduce the risk of coronary steal?

Third,

When a patient with a CABG history needs an AV access creation, should we always confirm which graft for CABG was used and which way of CABG operation was performed?

I'd like to appreciate your comments.

 

Hyungseok Lee, MD, FASDIN

Hallym University Sacred Heart Hospital, South Korea.

pcsacred@gmail.com

 

Tags:  CABG 

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