“Hot Ulcer” of the Hand Caused by Retrograde Flow of Arterialized Blood from an Arteriovenous Fistula

Abstract

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 ulceration may develop. Our observed case and systematic analysis of the literature show that these venous ulcers of the hand typically are associated with retrograde arterialization of distal fistula vein side branches. We suggest calling these hyperemic skin lesions “hot ulcers” in order to distinguish them from ischemic ulcers. In most instances, hot ulcers are curable by selective ligation of the venous tributaries. If proximal venous outflow is also obstructed, attempts of outflow reconstruction should be undertaken. If this is not feasible, the AV fistula needs to be completely reconstructed.