Angiosarcoma and Dialysis-related Arteriovenous Fistulae: A Comprehensive Review.
OBJECTIVE
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.


CONCLUSIONS
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.
West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK.
Y
Y
Oskrochi
Department of General Surgery, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK.
K
K
Razi
Department of Cancer Medicine and Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
J
J
Stebbing
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.
J
J
Crane
D000671:Amputation, Surgical; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000401:mortality; D006394:Hemangiosarcoma / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D010146:Pain / Q000209:etiology; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
Angiosarcoma; Arteriovenous fistula; Dialysis