Necrosis of the Hand After Daunorubicin Infusion Distal to an Arteriovenous Fistula

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Abstract
Patients with malignant disease who receive repeated intravenous injections of various chemotherapeutic agents may develop difficulty secondary to insufficient venous access. Previously reported experience with surgical arteriovenous fistulas (1) and bovine heterografts (2) has shown that these techniques may improve long-term venous access if they are used while a suitable vein for venous outflow still exists. The morbidity of these procedures has been related to the expected risks of the surgical procedures and, on occasion, to high output cardiac failure. Complications resulting from administration of drugs and blood products into the fistula have not been reported. We report here a