Y Oskrochi1, K Razi2, J Stebbing3, J Crane4. 1. West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK. 2. Department of General Surgery, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK. 3. Department of Cancer Medicine and Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. 4. West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK. Electronic address: j.crane@imperial.ac.uk.
Abstract
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.
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.
Authors: Andrea Boni; Giovanni Cochetti; Angelo Sidoni; Guido Bellezza; Emanuele Lepri; Andrea De Giglio; Morena Turco; Jacopo Adolfo Rossi De Vermandois; Michele Del Zingaro; Roberto Cirocchi; Ettore Mearini Journal: Open Med (Wars) Date: 2019-07-31
Authors: Dominic Heining; Jonathan Senior; Abheesh Prasad; Michael Thomas; Andrew Bentall; Phillip J Yates Journal: Oxf Med Case Reports Date: 2018-09-18