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Arteriovenous fistula from drug abuse. Implications for hemodialysis.

MAJOR surgical complications of intravascular drug abuse, including phlebitis, false aneurysm, and arterial thrombosis, have been reported from this 1 and other institutions. 2,3 Among the major medical problems is an increased incidence of chronic renal disease. 4,5 The unfortunate combination of renal failure and peripheral vascular damage is particularly detrimental to vascular access for longterm hemodialysis. We have seen yet another vascular complication, an arteriovenous fistula of the antecubital fossa that prompted the immediate failure of a Scribner hemodialysis shunt placed in the ipsilateral wrist. Report of a Case A 24-year-old man was hospitalized in January 1974, for shortness of breath, fatigue, epistaxis, and syncopal attacks. An episode of hematuria had occurred at the age of 9 years when he was told he had Bright disease. At the age of 17 years, he was rejected for military duty because of proteinuria. He admitted to repeated intravenous use of amphetamines,