• Dialysis patients with arteriovenous fistula who have central venous stenosis develop collateral veins in the axilla and chest wall.

  • These veins are at risk of spontaneous rupture, and major bleeding may occur.

  • Bleeding should be controlled immediately by using a compression bandage, and patients should be resuscitated with fluids and blood transfusion before surgical ligation of the bleeder.

  • Awareness of this complication and early protection can save the patient from life-threatening hemorrhage.


Bleeding is a well-known complication of arteriovenous fistula (AVF), either external bleeding from the fistula or hematoma formation. Other rare bleeding routes have been recorded as spontaneous hemothorax; however, to our knowledge, bleeding from a collateral chest wall vein has never been reported previously. We present a 54-year-old male with end-stage renal disease on hemodialysis. He had a brachiocephalic AVF with central venous stenosis resulting in collateral veins in the axilla and chest wall that ruptured spontaneously, causing significant bleeding. The bleeding was controlled by a bandage, the patient was resuscitated, and the bleeder was identified and ligated in operating room. Examining these patients for any infection, ulcers, or crusts over the dilated chest wall veins could save them from life-threatening hemorrhage.

You do not currently have access to this content.