Resolution of reactive angioendotheliomatosis in an arteriovenous fistula with innominate vein angioplasty

Abstract

Introduction: Arteriovenous fistulae (AVF)-associated reactive angioendotheliomatosis (RAE) is a very rare entity (three previously reported cases in the literature) that can manifest as extremity wounds. RAE’s etiopathology is unknown. Case description: We report a case of severe limb-threatening upper extremity wound with pathology-proven RAE. This lesion was previously refractory to standard wound care. There was no evidence of limb ischemia or steal syndrome, previously deemed to be the underlying cause of AVF-associated RAE in other reports. Conclusions: Successful endovascular treatment of an ipsilateral innominate vein stenosis led to reduction of venous hypertension, resolution of associated arm edema, and subsequent wound healing. We therefore propose that venous engorgement and hypertension from central venous stenosis is the likely underlying cause for AVF-associated RAE. If this rare entity is encountered in the setting of AVF, there is utility in treating the wound as a sentinel lesion and venography should be conducted to rule out central venous pathology. Vascular intervention complements aggressive local wound management and biopsy is requisite for prompt diagnosis.