Case 16: Diagnosis & Conclusions

Case Published: September 2018
Submitted By: Aisha Shaikh

Case 16 Index

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:

AVF rupture.png

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?

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
To avoid aneurysm formation, cannulation sites should be rotated. To prevent progression of aneurysms, outflow stenoses should be treated.

Case 16 Index
Case 16 Introduction
Case 16 Physical Exam
Case 16 Diagnostic Testing