Massive Upper-Extremity Edema Following Forearm Fistula: Cause and Treatment With Salvage of the Fistula

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Abstract
To the Editor. —Among the complications of arteriovenous fistulas created for hemodialysis, one of the most challenging to treat is massive arm edema. We report a case of massive arm edema with threatened gangrene following the formation of a forearm fistula in which the arm and fistula were salvaged by axillary vein–to–axillary vein bypass. Report of a Case. —A left forearm loop fistula was created in a 68-year-old woman whose history included a previous left subclavian hemodialysis catheter. Postoperatively, the patient developed massive left arm edema, leading to pregangrenous changes in her fingers. A presumptive diagnosis of proximal venous obstruction was made. In an effort to salvage not only the arm but also the fistula, we performed left axillary vein–to–right axillary vein polytetrafluoroethylene bypass after operative venography (Figure), which demonstrated a completely thrombosed left innominate vein. The postoperative course was extraordinarily rewarding, with overnight relief of considerable arm edema

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