Experience with ulcerated, bleeding autologous dialysis fistulas.

Purpose: The incidence of ulcerated, bleeding, autologous, hemodialysis fistulas has been felt to be increasing in recent years. This review was undertaken to examine our experience with patients who presented with episodes of spontaneous bleeding in the presence of an ulcerated lesion over their autologous dialysis accesses.

Methods: A database of hemodialysis access procedures was reviewed for individuals with spontaneous bleeding from ulcerations. Twenty-four patients were identified with 28 ulcerating lesions over a ten-year period from 2001 to 2011. Each had at least a single episode of spontaneous bleeding. Treatment methods were reviewed including five techniques of surgical intervention.

Results: Two of 24 patients expired from major hemorrhagic events before obtaining surgical consultation (8.3%). Twenty-one patients (87.5%) underwent 28 surgical procedures for correction of the ulcers. One patient (4.1%) with simultaneous ulcers healed under antibiotic therapy during close observation in hospital. Simple suturing of the ulcer was found to be inconsistent in effectively maintaining hemostasis. Surgical excision of the ulcer with primary closure, vein patching of the fistula, or end-end anastomosis were equally effective in definitively correcting the problem.

Conclusions: The ulcerated autologous dialysis fistula is a life-threatening lesion and requires prompt surgical intervention to reduce mortality. The frequency of this problem appears to be increasing. Simple suturing of the ulcers was not consistently effective in remedying the problem and should be utilized as a temporizing measure until surgical correction can be undertaken. Fistulas can be uniformly salvaged with surgical intervention enabling uninterrupted dialysis treatments.