Ulceration of the hand secondary to a radial arteriovenous fistula: a model for varicose ulceration.

Wood, M.L.; Reilly, Graham D.; Smith, Guy T

doi:10.1136/bmj.287.6400.1167

Cited by 21 publications

(14 citation statements)

References 3 publications

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“…91 Pericapillary cuffs, dermal edema, and intimal proliferation were observed in biopsy specimens taken from the index finger or first web space of patients with upper extremity access grafts and signs of venous hypertension. 89,90 Peroxidase-antiperoxidase staining confirmed the presence of fibrin. 90 Monoclonal antibodies and immunofluorescence studies confirmed the presence of fibrin in the cuffs as well as plasminogen activator inhibitor-1; the latter is suggestive of impaired breakdown of fibrin.…”

Section: Clinical Features Of V-htnmentioning

confidence: 82%

“…89,90 Peroxidase-antiperoxidase staining confirmed the presence of fibrin. 90 Monoclonal antibodies and immunofluorescence studies confirmed the presence of fibrin in the cuffs as well as plasminogen activator inhibitor-1; the latter is suggestive of impaired breakdown of fibrin. Less extensive fibrin cuffs were also observed in two side-to-side autogenous AV accesses, but none in three end-to-end autogenous AV accesses or controls.…”

Section: Clinical Features Of V-htnmentioning

confidence: 82%

“…Unless the practitioner is familiar with the findings of distal V-HTN, the symptoms may be mistaken for infection or allowed to persist until infection supervenes. 88,90,93 With a side-to-side radiocephalic AV access, these findings were most commonly seen on the thumb and index finger, presumably because the incompetent valves producing the V-HTN were in the distal drainage pattern of the cephalic vein. 72, 87 The appropriate management is to convert the side-to-side configuration to a functional end-toside by ligation of the incompetent, distal outflow vein.…”

Section: Valvular Insufficiencymentioning

confidence: 95%

“…[82][83][84][85] The severe V-HTN produced with a functioning AV access may also produce the typical extremity findings associated with chronic venous insufficiency, including pigmentation, thickening, induration, and even ulceration of the skin. 72,73,[86][87][88][89][90][91] Patent side branches between the anastomosis and an outflow stenosis in an autogenous AV access, 92,93 or a radiocephalic side-to-side anastomosis, 89,90 divert the AV access flow into the patent collateral venous bed, resulting in distal edema. Persistence of V-HTN will typically produce these symptoms in the first through fourth digits of the hand.…”

Section: Clinical Features Of V-htnmentioning

confidence: 98%

“…This may be mistaken for infection, but will only resolve with correction of the V-HTN. 88,90,93 Pathophysiology Flow in the radial artery increases from 30 to 300 mL/min after construction of a radiocephalic AV access. 94 Mean flow using ultrasound-detected indicator dilution is 645 mL/min for radiocephalic and 1336 mL/min for brachiocephalic autogenous AV accesses.…”

Section: Clinical Features Of V-htnmentioning

confidence: 99%

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Complications of arteriovenous hemodialysis access: Recognition and management

Padberg

Calligaro

Sidawy³

2008

Journal of Vascular Surgery

211

262

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English language citations reporting complications of arteriovenous access for hemodialysis are critically reviewed and discussed. Venous hypertension, arterial steal syndrome, and high-output cardiac failure occur as a result of hemodynamic alterations potentiated by access flow. Uremic and diabetic neuropathies are common but may obfuscate recognition of potentially correctable problems such as compression or ischemic neuropathy. Mechanical complications include pseudoaneurysm, which may develop from a puncture hematoma, degeneration of the wall, or infection. Dysfunctional hemostasis, hemorrhage, noninfectious fluid collections, and access-related infections are, in part, manifestations of the adverse effects of uremia on the function of circulating hematologic elements. Impaired erythropoiesis is successfully managed with hormonal stimulation; perhaps, similar therapies can be devised to reverse platelet and leukocyte dysfunction and reduce bleeding and infectious complications.

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Section: Clinical Features Of V-htnmentioning

confidence: 82%

Section: Clinical Features Of V-htnmentioning

confidence: 82%

Section: Valvular Insufficiencymentioning

confidence: 95%

Section: Clinical Features Of V-htnmentioning

confidence: 98%

Section: Clinical Features Of V-htnmentioning

confidence: 99%

See 3 more Smart Citations

Complications of arteriovenous hemodialysis access: Recognition and management

Padberg

Calligaro

Sidawy³

2008

Journal of Vascular Surgery

211

262

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Effect of venous hypertension on canine hind limb lymph

Leach

Browse

1985

Journal of British Surgery

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The effect of acute and chronic venous hypertension on the lymph draining from the hind limb has been studied in 10 dogs. Acute venous hypertension was produced by venous occlusion, and chronic venous hypertension by fashioning an arteriovenous fistula in the groin. Acute venous hypertension trebled the lymph flow and doubled its fibrinogen concentration thus increasing the net transport of fibrinogen across the interstitial space by 600 per cent. Chronic venous hypertension had a similar effect and caused the appearance of alpha-2-antiplasmin in the lymph. The fibrinolytic activity of the lymph did not change significantly in either group of experiments. These results suggest that the deposition of interstitial fibrin seen in the skin of the postphlebitic limb is related to an increased concentration of interstitial fluid fibrin, and to the appearance of the fibrinolytic inhibitor, alpha-2-antiplasmin, without a concomitant increase of fibrinolytic activator.

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Oxygen tension on the skin of the gaiter area of limbs with venous disease

Clyne

Ramsden

Chant

et al. 1985

Journal of British Surgery

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We examined the levels of oxygen on the skin of the gaiter areas of limbs with venous disease using a Roche Transcutaneous pO2 Monitor to determine whether hypoxia contributes to the skin changes and ulceration associated with severe venous disease. We studied patients with superficial varicose veins and no skin changes (Group 1: n = 25), patients with skin changes and healed ulcers (Group 2: n = 15), and an age matched normal control group (controls: n = 25). TcpO2 measurements were taken 5 cm above the medial malleolus with the limb both horizontal and vertical using a Roche Transcutaneous pO2 Monitor. A standard heel-raising test using a Medisonics Photoplethysmograph indicated the degree of venous insufficiency present. Results show that Group 1 patients and controls have similar skin oxygen levels (Group 1: TcpO2 66.48 + 14.12 mmHg; controls: TcpO2 61.60 +/- 11.02 mmHg) whereas those with skin changes and ulceration have significantly lower oxygen levels (Group 2: TcpO2 46.57 +/- 9.70 mmHg, t = 4.29, P less than 0.001). Group 2 patients did not show a significant rise in TcpO2 levels in the standing position whereas Group 1 patients and controls did (t = 2.6, P less than 0.02). PPG post-exercise recovery times confirmed differences between the three groups. These findings show that significant skin hypoxia occurs on the gaiter area of limbs with severe venous disease and support the concept of an oxygen diffusion block.

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Ulceration of the hand secondary to a radial arteriovenous fistula: a model for varicose ulceration.

Cited by 21 publications

References 3 publications

Complications of arteriovenous hemodialysis access: Recognition and management

Complications of arteriovenous hemodialysis access: Recognition and management

Effect of venous hypertension on canine hind limb lymph

Oxygen tension on the skin of the gaiter area of limbs with venous disease

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