Pain is a prevalent cause of medical consultation among dialysis patients, severely impacting both treatment outcomes and quality of life. This study focuses on a specific yet underexplored type of pain—delayed and progressive perivenous tissue pain in the outflow tract of arteriovenous fistulas (AV fistula) during dialysis. The aim is to summarize its clinical features, investigate its underlying mechanisms, and evaluate the effectiveness of various treatments, ultimately providing new insights into pain management.

Methods

This study included 36 patients who experienced delayed and progressive perivenous tissue pain in the outflow tract of AV fistulas during dialysis. Pain features were systematically summarized, and the AV fistula status was comprehensively evaluated through general observation, physical examination, and imaging. A series of trial interventions were employed to further explore the underlying mechanisms of pain. Based on these findings, appropriate treatment strategies were identified and implemented, with therapeutic outcomes monitored over a 12-month follow-up.

Findings

The specific pain may be closely associated with venous hypertension. Ultrasonography identified high-flow fistulas in 18 patients, while angiography revealed varying degrees of outflow vein stenosis in 23 patients. Five patients with slightly elevated fistula blood flow and no significant stenosis underwent bandage compression therapy. Thirty-one patients with markedly increased blood flow and/or outflow vein stenosis received ultrasound-guided flow restriction surgery, percutaneous transluminal angioplasty, or combined therapies. All patients achieved pain relief, with no recurrence during the follow-up period.

Conclusions

This study systematically investigates perivenous tissue pain in the outflow tract of AV fistula during dialysis. Venous hypertension is likely the primary underlying cause of this condition. Treatment options, including bandage compression, flow restriction surgery, percutaneous transluminal angioplasty, and combined therapies, effectively alleviate the tissue pain.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data used to support the findings of this study are available from the first author and the corresponding author upon request.

References

1 S. N. Davison and G. S. Jhangri, “The Impact of Chronic Pain on Depression, Sleep, and the Desire to Withdraw From Dialysis in Hemodialysis Patients,” Journal of Pain and Symptom Management 30, no. 5 (2005): 465–473.
10.1016/j.jpainsymman.2005.05.013
PubMed Web of Science® Google Scholar
2 K. Kitala-Tańska, E. Kania-Zimnicka, D. Tański, N. Kwella, T. Stompór, and M. Stompór, “Prevalence and Management of Chronic Pain, Including Neuropathic Pain, in Dialysis Patients With End-Stage Renal Disease,” Medical Science Monitor 30 (2024): e943808.
10.12659/MSM.943808
PubMed Web of Science® Google Scholar
3 E. Lambourg, L. Colvin, G. Guthrie, et al., “The Prevalence of Pain Among Patients With Chronic Kidney Disease Using Systematic Review and Meta-Analysis,” Kidney International 100, no. 3 (2021): 636–649.
10.1016/j.kint.2021.03.041
PubMed Web of Science® Google Scholar
4 M. K. Marzouq, A. F. Samoudi, A. Samara, S. H. Zyoud, and S. W. Al-Jabi, “Exploring Factors Associated With Pain in Hemodialysis Patients: A Multicenter Cross-Sectional Study From Palestine,” BioMed Central Nephrology 22, no. 1 (2021): 96.
10.1186/s12882-021-02305-1
PubMed Web of Science® Google Scholar
5 P. C. Pham, K. Khaing, T. M. Sievers, et al., “2017 Update on Pain Management in Patients With Chronic Kidney Disease,” Clinical Kidney Journal 10, no. 5 (2017): 688–697.
10.1093/ckj/sfx080
CAS PubMed Web of Science® Google Scholar
6 K. Kukita, S. Ohira, I. Amano, et al., “2011 Update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis,” Therapeutic Apheresis and Dialysis 19, no. 1 (2015): 1–39.
10.1111/1744-9987.12296
PubMed Google Scholar
7 C. E. Lok, T. S. Huber, T. Lee, et al., “KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update,” American Journal of Kidney Diseases 75, no. 2 (2020): S1–S164.
10.1053/j.ajkd.2019.12.001
PubMed Google Scholar
8 S. Zyga, V. Alikari, A. Sachlas, et al., “Management of Pain and Quality of Life in Patients With Chronic Kidney Disease Undergoing Hemodialysis,” Pain Management Nursing 16, no. 5 (2015): 712–720.
10.1016/j.pmn.2015.03.004
PubMed Web of Science® Google Scholar
9 F. Coluzzi, “Assessing and Treating Chronic Pain in Patients With End-Stage Renal Disease,” Drugs 78, no. 14 (2018): 1459–1479.
10.1007/s40265-018-0980-9
CAS PubMed Web of Science® Google Scholar
10 M. L. E. Stor, M. M. Lokhorst, S. E. R. Horbach, et al., “Clinical Characteristics Associated With Pain in Patients With Peripheral Vascular Malformations,” Journal of Vascular Surgery 75, no. 3 (2022): 1054–1062.e1.
10.1016/j.jvs.2021.08.101
PubMed Web of Science® Google Scholar
11 Y. Muromiya, K. Nagai, N. Yokota, et al., “Factors Associated With Pain During Vascular Access Intervention Therapy,” Journal of Vascular Access 16, no. 10 (2015): S43–S45.
10.5301/jva.5000425
PubMed Google Scholar
12 J. H. Tordoir, M. M. van Loon, N. Zonnebeld, M. Snoeijs, and F. van Nie, “Surgical Intervention for Upper Extremity Nerve Compression Related to Arteriovenous Hemodialysis Accesses,” Journal of Vascular Access 22, no. 1 (2021): 58–63.
10.1177/1129729820922711
PubMed Web of Science® Google Scholar
13 K. Leivaditis, S. Panagoutsos, A. Roumeliotis, V. Liakopoulos, and V. Vargemezis, “Vascular Access for Hemodialysis: Postoperative Evaluation and Function Monitoring,” International Urology and Nephrology 46, no. 2 (2014): 403–409.
10.1007/s11255-013-0564-2
PubMed Web of Science® Google Scholar
14 N. Koirala, E. Anvari, and G. McLennan, “Monitoring and Surveillance of Hemodialysis Access,” Semin Intervent Radiol 33, no. 1 (2016): 25–30.
10.1055/s-0036-1572548
PubMed Web of Science® Google Scholar
15 R. Bodington, S. Greenley, and S. Bhandari, “Getting the Basics Right: The Monitoring of Arteriovenous Fistulae, a Review of the Evidence,” Current Opinion in Nephrology and Hypertension 29, no. 6 (2020): 564–571.
10.1097/MNH.0000000000000644
PubMed Web of Science® Google Scholar
16 R. F. Neville, C. J. Abularrage, P. W. White, and A. N. Sidawy, “Venous Hypertension Associated With Arteriovenous Hemodialysis Access,” Seminars in Vascular Surgery 17, no. 1 (2004): 50–56.
10.1053/j.semvascsurg.2003.11.002
PubMed Google Scholar
17 B. Bucktowarsing, Y. Vin, and E. V. Lerma, “The Clinical Relevance and Management of High-Flow Arteriovenous Access,” Advances in Chronic Kidney Disease 27, no. 3 (2020): 214–218.
10.1053/j.ackd.2020.03.001
PubMed Web of Science® Google Scholar
18 A. K. Agarwal, “Endovascular Interventions for Central Vein Stenosis,” Kidney Research and Clinical Practice 34, no. 4 (2015): 228–232.
10.1016/j.krcp.2015.10.005
PubMed Google Scholar
19 A. K. Agarwal, “Central Vein Stenosis,” American Journal of Kidney Diseases 61, no. 6 (2013): 1001–1015.
10.1053/j.ajkd.2012.10.024
PubMed Web of Science® Google Scholar
20 J. Ibeas, R. Roca-Tey, J. Vallespín, et al., “Spanish Clinical Guidelines on Vascular Access for Haemodialysis,” Nefrología 39, no. 6 (2019): 680–682.
10.1016/j.nefro.2019.09.001
PubMed Web of Science® Google Scholar
21 M. Harris and C. S. Lim, “Chronic Venous Outflow Obstruction: An Important Cause of Chronic Venous Disease,” Cleveland Clinic Journal of Medicine 88, no. 12 (2021): 680–688.
10.3949/ccjm.88a.21068
PubMed Web of Science® Google Scholar
22 M. A. Anwar, J. Shalhoub, C. S. Lim, M. S. Gohel, and A. H. Davies, “The Effect of Pressure-Induced Mechanical Stretch on Vascular Wall Differential Gene Expression,” Journal of Vascular Research 49, no. 6 (2012): 463–478.
10.1159/000339151
CAS PubMed Web of Science® Google Scholar
23 A. Mansilha and J. Sousa, “Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy,” International Journal of Molecular Sciences 19, no. 6 (2018): 1669.
10.3390/ijms19061669
PubMed Web of Science® Google Scholar
24 H. M. Koncicki, F. Brennan, K. Vinen, and S. N. Davison, “An Approach to Pain Management in end Stage Renal Disease: Considerations for General Management and Intradialytic Symptoms,” Seminars in Dialysis 28, no. 4 (2015): 384–391.
10.1111/sdi.12372
PubMed Web of Science® Google Scholar
25 S. Tharwat, E. Nagy, M. Mohsen, and M. K. Nassar, “Ultrasound Versus Magnetic Resonance Imaging in the Evaluation of Shoulder Pain in End Stage Renal Disease Patients on Chronic Hemodialysis,” International Journal of Clinical Practice 2022 (2022): 1315446.
10.1155/2022/1315446
PubMed Web of Science® Google Scholar
26 S. Oga, K. Goto, J. Sakamoto, et al., “Mechanisms Underlying Immobilization-Induced Muscle Pain in Rats,” Muscle & Nerve 61, no. 5 (2020): 662–670.
10.1002/mus.26840
CAS PubMed Web of Science® Google Scholar
27 I. Urits, A. H. Shen, M. R. Jones, O. Viswanath, and A. D. Kaye, “Complex Regional Pain Syndrome, Current Concepts and Treatment Options,” Current Pain and Headache Reports 22, no. 2 (2018): 10.
10.1007/s11916-018-0667-7
PubMed Web of Science® Google Scholar
28 A. Jafari-Koulaee, M. Moosazadeh, M. Bagheri Nesami, and A. H. Goudarzian, “Effect of Cryotherapy on Arteriovenous Fistula Puncture-Related Pain in Hemodialysis Patients: A Systematic Review and Meta-Analysis,” Complementary Therapies in Medicine 49 (2020): 102326.
10.1016/j.ctim.2020.102326
PubMed Web of Science® Google Scholar
29 D. Fulker, A. Simmons, K. Kabir, L. Kark, and T. Barber, “The Hemodynamic Effects of Hemodialysis Needle Rotation and Orientation in an Idealized Computational Model,” Artificial Organs 40, no. 2 (2016): 185–189.
10.1111/aor.12521
PubMed Web of Science® Google Scholar
30 L. M. Mendell, “Constructing and Deconstructing the Gate Theory of Pain,” Pain 155, no. 2 (2014): 210–216.
10.1016/j.pain.2013.12.010
PubMed Web of Science® Google Scholar
31 E. E. Bagley and S. L. Ingram, “Endogenous Opioid Peptides in the Descending Pain Modulatory Circuit,” Neuropharmacology 173 (2020): 108131.
10.1016/j.neuropharm.2020.108131
CAS PubMed Web of Science® Google Scholar
32 B. A. Kimmey, N. M. McCall, L. M. Wooldridge, T. D. Satterthwaite, and G. Corder, “Engaging Endogenous Opioid Circuits in Pain Affective Processes,” Journal of Neuroscience Research 100, no. 1 (2022): 66–98.
10.1002/jnr.24762
CAS PubMed Web of Science® Google Scholar

Volume29, Issue3

July 2025

Pages 294-302

Analysis and Management of Perivenous Tissue Pain in the Outflow Tract of Arteriovenous Fistulas During Dialysis

ABSTRACT

Background

Methods

Findings

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Information

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Analysis and Management of Perivenous Tissue Pain in the Outflow Tract of Arteriovenous Fistulas During Dialysis

ABSTRACT

Background

Methods

Findings

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Related

Information