Exsanguination from iatrogenic puncture of arteriovenous fistula

  • Ludwig Kutschera
  • Carsten Babian
  • Rexson Tse
  • Jan Dreßler
  • Benjamin OndruschkaEmail author
Letter to the Editor

We read with great interest the recent case report by Živcović et al. [1] reporting a suicide death by exsanguination from a puncture wound to an arteriovenous fistula using a Swiss knife. We report another similar death in which the manner of death was accidental (iatrogenic) rather than suicidal.

An 85 year old man was found dead at home in a chair. At the scene, his right arm was wrapped in blood soaked masking tape. Directly below his right arm was a pool of blood. The death was initially treated as suspicious requiring forensic investigation by police and a forensic pathologist to establish the cause and manner of death.

The deceased was known to suffer from end-stage kidney disease (Fig.  1a) requiring dialysis via an arteriovenous fistula created in his right forearm. Initial examination at the scene showed two puncture wounds adjacent to the arteriovenous fistula with surrounding bruising (Fig. 1c). No objects that would have caused these puncture wounds were identified around...



The authors would like to thank the public prosecution office for the approval to publish the case report.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ludwig Kutschera
    • 1
  • Carsten Babian
    • 1
  • Rexson Tse
    • 2
  • Jan Dreßler
    • 1
  • Benjamin Ondruschka
    • 1
    Email author
  1. 1.Institute of Legal MedicineUniversity of LeipzigLeipzigGermany
  2. 2.Department of Forensic Pathology, LabPLUSAuckland City HospitalAucklandNew Zealand

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