Keywords
venous hypertension
Hemodialysis access
Brachiobasilic fistula
How to Cite
Abstract
Background: Venous hypertension is a rare complication that occurs following the surgical formation of arteriovenous fistulas (AVFs) for hemodialysis. Clinical signs in its early stage may resemble cellulitis, ischemic steal syndrome, or thrombosis, thus complicate the diagnosis and lead to improper AVF maturation.
Case presentation: A male patient aged 64 years with end-stage chronic kidney disease underwent left brachiobasilic AVF creation. He started developing swelling, edema, pain, digital cyanosis, and intermittent fever shortly after the operation. Although Doppler ultrasonography showed AVF patency without any signs of thrombosis or stenosis, the flow through the fistula was not sufficient for hemodialysis. Neither clinical treatment nor time could solve his symptoms and improve the maturation of the fistula; hence, the use of a temporary central venous catheter became necessary.
Methods: This paper is a focused PubMed literature search aiming at identifying studies that discuss postoperative venous hypertension as well as complications involving AVFs. Present clinical presentation was compared with those discussed in selected articles.
Results: Persistent venous congestion, cyanosis, and poor AVF maturation strongly suggested postoperative venous hypertension despite preserved thrill and Doppler-confirmed patency. Surgical ligation performed eight weeks after AVF creation resulted in rapid resolution of swelling, cyanosis, and pain.
Conclusions: Early postoperative venous hypertension should be suspected in patients with persistent swelling, cyanosis, pain, or failure of AVF maturation, even in the absence of thrombosis or critical stenosis. Prompt recognition may prevent prolonged morbidity and unsuccessful vascular access outcomes.
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