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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