Blum NA, Olivares-Cruz S, Lecuona-Huet NE, Fabián-Mijangos W, Muñoz-Vigna RA, Ziga-Martínez A

Language: Spanish
References: 11
Page: 33-38
PDF size: 185.94 Kb.

ABSTRACT

Introduction. The autologous arteriovenous fistula represents the vascular access of choice for hemodialysis. A common complication is the presence of persistent bleeding through the puncture sites performed during hemodialysis sessions. Infections of these fistulas are quite rare with an incidence of 0.5 to 5% per year, but even more challenging to solve are the hematomas associated with infections that occur in a frequency of 0.56 to 4.5%, which require a more complex management.
Clinical case. A 29-year-old female patient with chronic renal disease KDOQI 5 on hemodialysis, secondary to pre-eclampsia, who underwent arteriovenous fistula on the right thoracic limb. This fistula was used during 8 months and after a session of hemodialysis the patient presents increase of volume of the right thoracic limb accompanied by heat, pulsatile type pain that radiates to forearm and nervous compromise. She was admitted to the Hospital with post-puncture hematoma diagnosis, double antibiotic coverage is initiated and hematoma drainage is performed. Subsequently it is complemented with surgical debridement and placement of negative pressure system to achieve closure of the wound and the fistula was saved.
Conclusion. It is important to make an adequate diagnosis of complications in arteriovenous fistulas. In addition, it is important to keep in mind all possible therapeutic options and to consider the negative pressure system as a valid alternative to reduce the closing time of wounds with adjacent arterial vessels, to reduce costs, to avoid reinfections and to shorter hospital stay in order to increase the life of the fistula.

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