UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Sam Ghali (@EM_Resus)

Posted: 2/9/2015 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Question

66 year-old male presents with pain & swelling of his right upper arm for 2 days. He has a history of hypertension, diabetes, and renal transplant. Vital signs are normal. What's the diagnosis?

Answer

Thrombosed AV Fistula

AV Fistula Thrombosis

Hemodialysis fistulas are surgically created communications between a native artery and vein, allowing faster rates of blood flow required for HD.
This patient had a brachio-cephalic AV Fistula that was used for hemodialysis prior to his renal transplant but has since thrombosed; thrombosis is not an uncommon complication of fistulas.
Between 85% and 90% of AV fistula thrombosis is associated with venous stenosis, which increases resistance to blood flow and results in increased venous pressure, decreased blood flow, and ultimately thrombosis. Treatment includes endovascular and surgical interventions.
There was no reason for salvage in this case because the patient no longer used the fistula; he was treated conservatively with arm elevation and warm compresses.

Much thanks to Dr. Sam Ghali (@EM_ResUS) for the great case!

References

http://www.acep.org/Clinical---Practice-Management/Focus-On--Dialysis-Access-Emergencies/

http://emedicine.medscape.com/article/419393-overview

References

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