Abstract

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.