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Angiosarcoma and Dialysis-related Arteriovenous Fistulae: A Comprehensive Review
Y Oskrochi1, K Razi2, J Stebbing3
1West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK.
Insights
Angiosarcoma in arteriovenous fistulae (AVF) can present as pain or a mass, often misdiagnosed initially. Early suspicion and investigation of AVF changes are crucial for timely diagnosis and management.
Area of Science:
- Vascular Surgery
- Oncology
- Nephrology
Background:
- Arteriovenous fistulae (AVF) are essential for haemodialysis access.
- Angiosarcoma is a rare but aggressive malignancy that can arise in vascular structures.
- Understanding angiosarcoma in AVF is critical for patient outcomes.
Purpose of the Study:
- To review cases of angiosarcoma in AVF used for haemodialysis.
- To analyze presentation, diagnosis, and management strategies.
- To improve early detection and treatment protocols.
Main Methods:
- Systematic literature search of Embase, AMED, HMIC, and MEDLINE databases.
- Independent article extraction by two authors following PRISMA standards.
- Review of 22 unique patient cases meeting inclusion criteria.
Main Results:
- Twenty-two cases identified: 20 men, mean age 54.9 years; 19 post-transplant, 18 on antirejection agents.
- Common symptoms: pain +/- mass. Initial misdiagnosis: thrombosis/infection. Diagnostic interval: 2-40 weeks.
- Mean time to symptoms: 118.9 months (fistula), 96.9 months (transplant). Amputation most common treatment; mean survival: 8.8 months.
Conclusions:
- Suspect angiosarcoma in quiescent AVF presenting with pain, especially with rapidly enlarging mass or bleeding.
- Alarm indicators warrant urgent investigation per cancer guidelines.
- Incorporate routine histological sampling in all AVF surgical procedures.
Objective/Background:
To conduct a comprehensive review of cases, presentation, diagnosis, and management of angiosarcoma in arteriovenous fistulae (AVF) created for haemodialysis.
Methods:
Two authors independently conducted systematic searches and extraction of articles from the Embase, AMED, Health Management Information Consortium, and MEDLINE databases in keeping with the inclusion/exclusion criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.
Results:
Twenty-two unique patient cases were identified; 20 of the cases were men and mean ± SD age of presentation was 54.9 ± 13.6 years. Nineteen cases were post-transplant and 18 were on antirejection agents. The most common presenting symptom was pain, with or without a mass. The initial diagnosis was most often thrombosis/infection of the AVF and the diagnostic interval to a correct diagnosis of angiosarcoma was between 2 and 40 weeks. Mean ± SD time to presentation of symptoms from fistula formation was 118.9 ± 57.5 months, while from transplant it was 96.9 ± 70.0 months. Amputation was the most common treatment modality and mean ± SD survival was 8.8 ± 3.7 months.
Conclusion:
Angiosarcoma should be suspected in previously quiescent AVF that presents with pain. The presence of a rapidly enlarging mass or bleeding/bruising should be taken as alarm indicators and warrant urgent investigation in accordance with local cancer guidelines. Any surgical procedure should involve histological samples as a matter of course.
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