Acute and Chronic Venous Insufficiency in the Finger

Abstract

Venous hypertension with subsequent chronic venous insufficiency and its sequelae in the hand is reported as an uncommon complication of arteriovenous fistulae for hemodialysis.

Complications of arteriovenous hemodialysis access: Recognition and management

“…[71][72][73] The most common manifestation of V-HTN is regional edema, although other typical signs and symptoms such as pigmentation, induration, dermatosclerosis, and ulceration may be produced. The pathophysiology is straightforward but is frequently misunderstood or misdiagnosed.…”

“…[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.…”

“…88,92,93 Management options include ligation of the incompetent branch vein feeding the distal superficial veins or relief of the obstruction, or both. 73,87,92 Alternatively, if the access site can be sacrificed, the AV access can always be ligated. 72,88,92,93 A similar syndrome may develop with an prosthetic AV access when intervening branches are present between the outflow anastomosis and a more proximal obstruction in the outflow vein.…”