Hindawi Publishing Corporation Case Reports in Transplantation Volume 2013, Article ID 197524, 3 pages http://dx.doi.org/10.1155/2013/197524 Case Report Acute Renal Failure and Volume Overload Syndrome Secondary to a Femorofemoral Arteriovenous Fistula Angioplasty in a Kidney Transplant Recipient Dominique Bertrand, Geoffroy Desbuissons, Nicolas Pallet, Albane Sartorius, Christophe Legendre, Marie-France Mamzer, and Rebecca Sberro Soussan Service de Transplantation R´ enale et Soins Intensifs, Hˆ opital Necker, Assistance Publique Hˆ opitaux de Paris, Universit´ e Paris Descartes, 75015 Paris, France Correspondence should be addressed to Nicolas Pallet; npallet@yahoo.fr Received 8 January 2013; Accepted 30 January 2013 Academic Editors: P. A. Andrews, M. G. H. Betjes, and M. Sadeghi Copyright © 2013 Dominique Bertrand et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation ater transplantation modiies hemodynamic parameters and kidney function. We report a case of a renal transplant recipient who developed an acute congestive heart failure accompanied by renal failure, which were triggered by femorofemoral AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. his paper illustrates the potential deleterious consequences of high-output AVF ater kidney transplantation and raises considerations regarding the impact of the istula on cardiac status and kidney function ater kidney transplantation and, consequently, the management AVF ater transplantation. 1. Introduction Arteriovenous istula (AVF) is the preferred access for hemodialysis, because of its longevity and resistance to infections [1]. However, large let-to-right shunts generate hemodynamic disturbances that may be deleterious for the cardiovascular system [2]. AVF induces a drop in peripheral vascular resistance, which leads to a compensatory increase in cardiac output. Sympathetic nervous system is activated, leading to an increasing pulse rate, stroke volume, and contractility. If high-output cardiac failure is underrecognized during hemodialysis, because of the absence of obvious volume overload, the deleterious cardiovascular efect of AVF can occur ater kidney transplantation. However, experimental and clinical studies analyzing the impact of AVF on cardio- vascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation ater transplantation modiies hemodynamic parameters and kidney function. here is no consensus regarding AVF man- agement ater kidney transplantation, and istula are usually ligated according to the patient wishes and if the clinical situation is controlled. Here we report a case of a renal transplant recipient with a femorofemoral AVF who developed an acute congestive heart failure accompanied by renal failure, which were triggered by AVF angioplasty. Prompt AVF ligation rapidly reversed clin- ical symptoms and normalized cardiac and renal functions. 2. Case A 51-year-old Caucasian woman was admitted to our depart- ment in April 2011 for a third kidney transplantation. Focal segmental glomerulosclerosis (FSGS) has been diagnosed in 1973, and the patient reached end-stage renal failure in 1982. He received two kidney allograts, in 1983 and 1993, which both failed as a consequence of early recurrence of FSGS. Since 2002, hemodialysis was performed on a let