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February 7, 1977

Unilateral Breast EnlargementA Complication of an Arteriovenous Fistula and Coincidental Subclavian Vein Occlusion

JAMA. 1977;237(6):571-572. doi:10.1001/jama.1977.03270330061023

SINCE hemodialysis has become a routine treatment for patients with end-stage renal disease, the surgically created arteriovenous (AV) fistula, first described by Brescia and Cimino in 1966, has become the vascular access of choice in most patients. In general, it is relatively simple and safe; but with an increasing number of these procedures being performed, one might anticipate an increasing prevalence of complications.

We report ipsilateral breast enlargement developing with the maturation of such a fistula and finally necessitating surgical closure of the fistula.

Report of a Case  A 71-year-old woman was found to have chronic renal failure in 1970 thought to be secondary to chronic pyelonephritis. An AV fistula (end of cephalic vein to side of radial artery) was created in her left forearm in March 1975, when her creatinine clearance was 8 ml/min; serum creatinine level, 5.1 mg/100 ml; and blood urea nitrogen level, 45 mg/100 ml. In