Case Published: September 2018
Submitted By: Aisha Shaikh
On Saturday (the following day), the patient’s AVF ruptures and EMS is called. After suture placement to temporarily control the bleeding sites, the patient was taken to the operating room immediately for AVF ligation:
Diagnosis: Ulcer Overlying Arteriovenous Fistula (AVF) Aneurysm & Rupture of AVF
Case Summary: Yikes, scary case! Here, we have an asymptomatic patient with an AVF presenting with an aneurysm and overlying ulcer.
Skin ulcers form over AV accesses, and more so over aneurysms and pseudoaneurysms as the skin over these areas is thin and fragile. Skin breakdown over the AV access can result in a potentially life threatening bleed, as in this patient. Close monitoring of aneurysms and physical examination findings should dictate the next steps. In addition to compressibility (aneurysms that are at low-risk for rupture should easily compress) here’s what to look for:
So, what should you do based on physical examination?
| APPEARANCE | RECOMMENDATION |
| Normal skin | Observe |
| Hypopigmented skin | Observe or elective repair |
| Shiny skin | Surgical repair |
| Eschar formation | Surgical repair |
| Ulcer | Surgical repair immediately |
| Rapidly enlarging aneurysm | Surgical repair |
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