Severe Hematoma Following Initial Arteriovenous Fistula Puncture in a Hemodialysis Patient, Emphasizing Thoracic Outlet Syndrome: A Case Report

BACKGROUND: Hematoma is a common complication following arteriovenous fistula (AVF) cannulation in hemodialysis patients; however, rapid progression to tension blister formation is rare. CASE REPORT: We describe a case involving a 62-year-old male on maintenance hemodialysis, who initially received treatment via a tunneled right internal jugular catheter with a polyester cuff. Approximately 10 weeks after the creation of a right forearm AVF, the patient underwent first-time AVF cannulation. After 2 h, he developed a hematoma at the puncture site, followed by extensive tension blisters the next day. Computed tomography angiography (CTA) revealed significant stenosis of the right subclavian vein. Conservative treatment, including antibiotics, microcirculation enhancement, and wound care, led to recovery. Based on this case, we revised our center's protocol for AVF assessment and early use during the first 3 months post-creation. CONCLUSIONS: In patients with newly matured AVFs-particularly those with a history of ipsilateral central venous catheterization-screening for thoracic outlet syndrome should be integrated into pre-cannulation assessments (e.g., AVF blood flow is dynamically evaluated with the arm in multiple positions). Standardizing AVF use during the activation period may reduce complications and help prolong fistula patency.