Ulceration of the hand secondary to a radial arteriovenous fistula: a model for varicose ulceration.

A patient in whom a radial arteriovenous fistula was constructed in preparation for haemodialysis subsequently developed ulceration on the dorsum of the hand. The lesion failed to heal despite antibiotic treatment, and so the fistula was closed. The lesion healed within three weeks. Subsequent construction of a fistula at the right wrist was followed 12 months later by the development of similar ulceration of the right hand. This complication of arteriovenous fistulas is similar to varicose ulceration of the leg and provides a unique opportunity to study the effects of sustained venous hypertension on the skin.