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Venous Hypertension Fistula Hand Swelling — ESENeph MCQ

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ModerateHaemodialysisVenous Hypertension Fistula Hand SwellingESENeph

A 55-year-old man on haemodialysis via a well-functioning brachiocephalic AV fistula develops progressive hand swelling and difficulty making a fist on the fistula arm. The hand is warm and well-perfused. What is the likely diagnosis?

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Correct answer: E — Venous hypertension from central venous stenosis or outflow obstruction – causing hand/arm swelling with preserved arterial inflow; fistulography or venography is needed to identify the stenosis

Hand/arm swelling with preserved arterial perfusion (warm, well-perfused) in a patient with an AV fistula suggests venous hypertension from outflow obstruction. This is different from steal syndrome (which causes ischaemia – cool, painful hand). Common causes include central venous stenosis (subclavian/brachiocephalic vein – often from previous central venous catheters), outflow vein stenosis, or accessory vein diversion. Diagnosis requires fistulography or venography. Treatment is endovascular angioplasty ± stenting. Untreated venous hypertension causes chronic swelling, skin changes, and access failure.

Reference: UKKA 2019 – VA; KDOQI 2019 – VA Update