Investigating risk factors and outcomes in rare disease of angiosarcomas in arteriovenous fistulas: A case report with review of literature

Angiosarcomas are rare, aggressive tumors with a poor prognosis. Early detection is essential, as surgically removing localized tumors gives the best chance for a cure. While angiosarcomas predominantly occur in the head and neck region, they can arise from endothelial cells lining blood or lymphatic vessels throughout the body. This case study highlights a rare instance of angiosarcoma developing in a non-functioning arteriovenous fistula (AVF) many years post-renal transplantation. A 50-year-old male with a history of end-stage renal disease (ESRD), initially treated with hemodialysis through a left brachiocephalic AVF, underwent a deceased donor kidney transplant in 2016. In March 2023, patient developed pain and numbness in his left hand, revealing a thrombosed AVF and chronic arterial occlusions. Surgical interventions included a left brachial-brachial artery bypass and ulnar endarterectomy, but his condition deteriorated, leading to the identification of a 4.9 × 3.1 × 2.4 cm mass in the proximal ulnar shaft in January 2024. Biopsy results confirmed epithelioid angiosarcoma, which was subsequently treated with left upper extremity amputation and tumor resection. Metastatic disease was detected in the right lung, necessitating further surgical interventions. This case underscores the necessity for vigilance in monitoring AVFs in transplant patients. We further completed a comprehensive literature review, using PubMed, Cochrane, and Google Scholar, from 2000 to 2024, focused on angiosarcoma arising from AVFs to provide further insights into the rare association between AVFs and angiosarcoma.