VENOUS HYPERTENSION OF THE HAND CAUSED BY HEMODIALYSIS SHUNT - IMMUNOFLUORESCENCE STUDIES OF PERICAPILLARY CUFFS

Background: Venous hypertension of the hand is an unusual complication of an arteriovenous shunt in patients receiving dialysis. Objective: We investigated whether in venous hypertension of the hand pericapilla ry cuffs are present and whether they consist of fibrin and other comp onents. Methods: Biopsy specimens were taken from three patients with a side-to-side shunt and venous hypertension of the hand, from three p atients with an end-to-side shunt without venous hypertension, and fro m three control subjects. The specimens were stained with antibodies a gainst fibrinogen, fibrin, plasminogen activator inhibitor-I, factor V III-related antigen, and collagen type IV. Results: Pericapillary cuff s consisting of fibrin only were observed in patients with venous hype rtension of the hand. In this fibrin network, factor VIII-related anti gen and collagen type IV were also present. The finding of plasminogen activator inhibitor-I in the pericapillary cuff in the patient with t he most severe signs of venous hypertension may indicate that breakdow n of this fibrin cuff is impaired. Conclusion: Pericapillary cuffs may be of pathogenetic significance in venous hypertension of the hand.