HOT ULCER OF THE HAND CAUSED BY RETROGRADE FLOW OF ARTERIALIZED BLOODFROM AN ARTERIOVENOUS-FISTULA - A CASE-REPORT

Venous hypertension of the hand and forearm is a rare complication of upper extremity arteriovenous (AV) fistula operations for hemodialysis . In severe cases of hand venous hypertension, nonischemic skin ulcera tion may develop. Our observed case and systematic analysis of the lit erature show that these venous ulcers of the hand typically are associ ated with retrograde arterialization of distal fistula vein side branc hes. We suggest calling these hyperemic skin lesions ''hot ulcers'' in order to distinguish them from ischemic ulcers. In most instances, ho t ulcers are curable by selective ligation of the venous tributaries. If proximal venous outflow is also obstructed, attempts of outflow rec onstruction should be undertaken. If this is not feasible, the AV fist ula needs to be completely reconstructed.