GUNSHOT WOUND IN ARTERIOVENOUS FISTULA FOR HEMODIALYSIS
Introduction:
The situations of violence in Colombia have the medical team in interesting and difficult challenges. The homicide rate was 52 per 100,000 habitants in Cali for 2021.
There are no reports in the world literature on this type of lesions in arteriovenous fistula
Methods:
Case report
Results:
This is the case of a 23-years-old patient, male, who received chronic hemodialysis for two years, he has a history of poor phosphorus management and mild hyperparathyroidism, and no record of hemodialysis complications (see Table No. 1).
He was admitted to the emergency department of a high-complexity hospital, after an impact from a firearm projectile precisely in his left antebrachial arteriovenous fistula, he was immediately taken to surgery with the following findings: segmental venous aneurysmal dilation, a cephalic vein in the distal arm and forearm thrombosed and proximal to the anastomosis with multiple lesions and endothelial compromise. Fistula in brachiocephalic configuration. (See imagine 1, 2 and 3)
Surgical procedure: A spindle incision is made over aneurysmal degeneration, vascular planes are identified, dissected by planes until vascular control, aneurysmal degeneration was observed, finding multiple mirror lesions on the posterior and anterior face of the venous segment, with significant tissue injury up to the distal third of the arm. Distal venous ligation is performed, it is dissected caudally until the lateral-terminal anastomosis is identified. The fistula is closed and medium-caliber vessels are repaired with the Carrel modified technique
Conclusions:
The blood flow from an arteriovenous fistula for hemodialysis is greater than 600ml/min, any injury is potentially lethal if not handled properly. These situations are a challenge for the medical team and a concern for health personnel and security agents
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.