Hand ulcers secondary to venous hypertension in wrist fistulas: A case series of a rare form of ischemia syndrome

An arteriovenous fistula (AVF) is the preferred permanent vascular access for long-term hemodialysis (HD) in patients with chronic kidney disease (CKD). Once adequately matured, an AVF provides usability over a long period of time. However, in rare cases, patients may develop fistula dysfunction accompanied by forearm swelling and/or signs of tissue injury with ischemic features in the setting of venous hypertension. This report presents three cases of patients with wrist AVFs who developed forearm venous hypertension and hand ulcers secondary to venous occlusion in the proximal forearm, an uncommon etiology of hand ischemia. These cases highlight the importance of a comprehensive clinical evaluation and timely intervention to alleviate symptoms while preserving vascular access integrity.