FATAL HEMORRHAGE FROM ARTERIOVENOUS DIALYSIS ACCESS SITE: A CASE REPORT

ALESSANDRO FEOLA¹, PASQUALE GIUGLIANO², FRANCESCO LA SALA³, CARMELA BUONOMO², BRUNO DELLA PIETRA³

¹Department of Biomedicine and prevention, University of Rome “Tor Vergata”, via Montpellier 1, 00133, Rome, Italy - ²A.O.R.N. Sant’Anna and San Sebastiano, Via Palasciano, 81100, Caserta, Italy - ³Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, via L. Armanni 5, 80138, Naples, Italy

Introduction: Surgical arteriovenous fistula is necessary to hemodialysis in order to have a continuous access to circulation. Complications related to a vascular access are aneurysms, vascular steal syndrome, venous hypertension, bleeding, infections and neurological disorders. The breakthrough bleeding of the fistula is a rare, but fatal, complication.

Case presentation: The Authors describe the case of a 53-year-old woman, suffering from cronic kidney disease (stage 5) with lateral arteriovenous fistula between the brachial artery and the median basilic vein, died after hemorrhage for rupture of the fistu- la. Autopsy revealed traumatic mechanism as genesis of fatal bleeding.

Conclusion: In case of fatal breakthrough bleeding of the fistula the forensic pathologist has to determine whether it is acci- dental event or otherwise to assess eventually liability in determining death.