title: Fatal exsanguination from hemodialysis vascular access sites.
abstract: Exsanguination from hemodialysis vascular sites may cause a rapid death. Due to extensive blood loss at the scene, investigators may initially suspect a homicide or suicide. We reviewed 100 deaths due to hemorrhage from hemodialysis shunt sites. The majority (81%) of these hemorrhages occurred at home and 44% subsequently died at home. Recognition of this medical complication at the scene is important to prevent the dispatch of the crime scene or homicide unit. In these instances, the common causes of kidney failure included hypertensive cardiovascular disease and diabetes mellitus. The manners of death were certified as therapeutic complication (93%), accident (5%), and suicide (2%). These fatal shunt hemorrhages are rapid and large due to their superficial subcutaneous locations and elevated shunt pressures from the arterial-venous anastamosis. The cause of death statement must include the proximate cause of death, which is usually the disease that resulted in kidney failure, if it is known.
authors.affiliation: New York City Office of Chief Medical Examiner, 520 First Avenue, New York, NY 10016, USA. JGILL@OCME.NYC.GOV
authors.forename: James R
authors.initials: JR
authors.lastname: Gill
authors.forename: Kara
authors.initials: K
authors.lastname: Storck
authors.forename: Sean
authors.initials: S
authors.lastname: Kelly
mesh_terms: D000059:Accidents / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000401:mortality*; D001344:Autopsy; D002423:Cause of Death; D003644:Death Certificates; D058734:Exsanguination / Q000209:etiology / Q000401:mortality*; D049429:Forensic Pathology; D006801:Humans; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D013405:Suicide; D013997:Time Factors; D055815:Young Adult