Ulceration of an autologous dialysis fistula can result in severe bleeding that can be life threatening.
Patient selection: autologous dialysis fistula
Presentation: ulceration over the fistula
Risk factors:
(1) aneurysm or pseudoaneurysm
(2) failure to use correct needle rotation
(3) infection in overlying tissue
Poor prognostic factors:
(1) delay in surgical consult
(2) failure to definitively fix the problem (using simple suturing of the ulcer)
(3) rapid rate of bleeding
Sometimes the connection between the fistula and the skin surface is thrombosed. This limits the amount of bleeding. Sudden displacement of the thrombus can be followed by massive bleeding.
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