Venous hypertension of the hand caused by hemodialysis shunt: immunofluorescence studies of pericapillary cuffs.
BACKGROUND
Venous hypertension of the hand is an unusual complication of an arteriovenous shunt in patients receiving dialysis.


OBJECTIVE
We investigated whether in venous hypertension of the hand pericapillary cuffs are present and whether they consist of fibrin and other components.


METHODS
Biopsy specimens were taken from three patients with a side-to-side shunt and venous hypertension of the hand, from three patients with an end-to-side shunt without venous hypertension, and from three control subjects. The specimens were stained with antibodies against fibrinogen, fibrin, plasminogen activator inhibitor-I, factor VIII-related antigen, and collagen type IV.


RESULTS
Pericapillary cuffs consisting of fibrin only were observed in patients with venous hypertension of the hand. In this fibrin network, factor VIII-related antigen and collagen type IV were also present. The finding of plasminogen activator inhibitor-I in the pericapillary cuff in the patient with the most severe signs of venous hypertension may indicate that breakdown of this fibrin cuff is impaired.


CONCLUSIONS
Pericapillary cuffs may be of pathogenetic significance in venous hypertension of the hand.
Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands.
M
M
Brakman
W R
WR
Faber
J E
JE
Zeegelaar
M T
MT
Bousema
J L
JL
van Proosdij
J A
JA
Kerckhaert
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002196:Capillaries / Q000737:chemistry; D003094:Collagen / Q000032:analysis; D005260:Female; D005337:Fibrin / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D005455:Fluorescent Antibody Technique; D006225:Hand / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D006435:Renal Dialysis / Q000009:adverse effects*; D014690:Venous Pressure; D014841:von Willebrand Factor / Q000032:analysis
D017395:Plasminogen Activator Inhibitor 1; D014841:von Willebrand Factor; D005337:Fibrin; D005340:Fibrinogen; D003094:Collagen