Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.190008
Jornal Vascular Brasileiro
Case Report

Úlceras de quirodáctilos e dorso de mão esquerda ocasionadas por hipertensão venosa após confecção de fístula arteriovenosa braquiocefálica: relato de caso

Ulcers of the fingers and dorsum of the left hand caused by venous hypertension after construction of a brachiocephalic arteriovenous fistula: case report

Aline Ioshie Akamine Asari; Daiane Cristina Ferreira Damasceno; Nathália Araújo de Almeida; Hícaro do Carmo Moreira; Ricardo André Viana Barros; Francisco Alberto Bezerra Ximenes Filho

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Resumo

Resumo: Úlceras venosas decorrentes de hipertensão venosa por fístula arteriovenosa são raras. A investigação de sua etiologia é esclarecida pelo eco-Doppler vascular, que diferencia entre estenose de vasos centrais e sobrecarga hemodinâmica gerada pelo desenvolvimento de tributárias, a partir da veia responsável pela fístula arteriovenosa. Apresentamos um caso gerado por sobrecarga hemodinâmica em tributária, que desviou o fluxo principal da fístula distalmente ao membro. Optamos por realizar a ligação da fístula para tratamento das úlceras e confecção de nova fístula arteriovenosa em membro contralateral.

Palavras-chave

fístula arteriovenosa, diálise renal, insuficiência renal crônica, úlcera cutânea

Abstract

Abstract: Venous ulcers caused by venous hypertension secondary to arteriovenous fistulae are rare. Their etiology can be confirmed by vascular Doppler ultrasonography, which can differentiate between stenosis of central vessels and hemodynamic overload caused by development of tributaries from the vein responsible for the arteriovenous fistula. We present a case caused by hemodynamic overload of a tributary, which diverted the primary flow from the fistula to the distal limb. We chose to ligate the fistula to treat the ulcers and create another arteriovenous fistula in the contralateral limb.
 

Keywords

arteriovenous fistula, renal dialysis, chronic renal failure, ulcer cutaneous

References

Debus ES, Sailer M, Voit R, Franke S. “Hot ulcer” of the hand caused by retrograde flow of arterialized blood from an arteriovenous fistula a case report. Vasc Surg. 1998;32(5):507-11. http://dx.doi.org/10.1177/153857449803200519.

Rasool S, Johnston GA, Bamford MW. A venous ulcer on the hand secondary to an arteriovenous fistula for hemodialysis treated successfully by transvenous embolization. Kidney Int. 2015;87(3):666. http://dx.doi.org/10.1038/ki.2014.264. PMid:25723643.

Neville RF, Abularrage CJ, White PW, Sidawy AN. Venous hypertension associated with arteriovenous hemodialysis access. Semin Vasc Surg. 2004;17(1):50-6. http://dx.doi.org/10.1053/j.semvascsurg.2003.11.002. PMid:15011180.

Fontseré N, Mestres G, Yugueros X, et al. Effect of a postoperative exercise program on arteriovenous fistula maturation: a randomized controlled trial. Hemodial Int. 2015;20(2):306-14. http://dx.doi.org/10.1111/hdi.12376. PMid:26486682.

Jaldin RG, Senefonte RA, Sobreira ML. Complicações relacionadas com o acesso arteriovenoso para hemodiálise. In: Maffei FHA, Yoshida WB, Rollo HA. Doenças vasculares periféricas. Rio de Janeiro: Guanabara Koogan; 2015. p. 1147-65.

Forsythe RO, Chemla ES. Surgical options in the problematic arteriovenous haemodialysis access. Cardiovasc Intervent Radiol. 2015;38(6):1405-15. http://dx.doi.org/10.1007/s00270-015-1155-7. PMid:26152505.

Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-10. http://dx.doi.org/10.1067/mva.2002.122025. PMid:11877717.

Suzuki M, Satoh N, Nakamura M, Horita S, Seki G, Moriya K. Bacteremia in hemodialysis patients. World J Nephrol. 2016;5(6):489-96. http://dx.doi.org/10.5527/wjn.v5.i6.489. PMid:27872830.

Balamuthusamy S, Reddi AL, Madhrira MH, et al. Clinical predictors of recurrent stenosis and need for re-intervention in the cephalic arch in patients with brachiocephalic AV fistulas. J Vasc Access. 2017;18(4):319-24. http://dx.doi.org/10.5301/jva.5000734. PMid:28665461.

Wilson SE. Complicações do acesso vascular: trombose, hipertensão venosa, insuficiência cardíaca congestiva, neuropatia e aneurisma. In: Wilson SE. Acesso vascular: princípios e prática. Osasco: di Livros Editora Ltda; 2012. p. 209-19.

Pajek J, Malovrh M. Preoperative ultrasound still valuable for radio-cephalic arteriovenous fistula creation? J Vasc Access. 2017;18(Suppl. 1):5-9. http://dx.doi.org/10.5301/jva.5000672. PMid:28297059.

Mittal V, Srivastava A, Kapoor R, et al. Management of venous hypertension following arteriovenous fistula creation for hemodialysis access. Indian J Urol. 2016;32(2):141-8. http://dx.doi.org/10.4103/0970-1591.174779. PMid:27127358.
 

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