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Rigsby DC, Clark TWI, Vance AZ, Chittams J, Cohen R, Mantell MP, Kobrin S, Trerotola SO. Percutaneous Management of Dialysis Access Steal Syndrome: Interventions and Outcomes from a Single Institution's 20-Year Experience. J Vasc Interv Radiol 2024; 35:601-610. [PMID: 38171415 DOI: 10.1016/j.jvir.2023.12.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE To determine safety and effectiveness of percutaneous interventions performed by interventional radiologists at a single institution over 2 decades in patients with dialysis access steal syndrome (DASS). MATERIALS AND METHODS A retrospective review of fistulograms from 2001 to 2021 (N = 11,658) was performed. In total, 286 fistulograms in 212 patients with surgically created dialysis accesses met inclusion criterion of fistulography for suspected DASS. Chart review collected data regarding patient demographics, comorbidities, access characteristics, fistulography findings, intervention(s) performed, and outcomes. Procedures with and without DASS intervention were compared. Odds ratios (ORs), adjusted for age, sex, comorbidities, access characteristics, and multiple within-patient events, were calculated using logistic regression to determine associations between steal intervention status and outcome variables: (a) major adverse events, (b) access preservation, and (c) follow-up surgery. A percutaneously treatable cause of DASS was present in 128 cases (45%). Treatment of DASS lesions was performed in 118 cases. Fifteen embolizations were also performed in patients without DASS lesions. RESULTS Technical success of DASS interventions, defined by the Society of Interventional Radiology (SIR) reporting standards, was 94%; 54% of interventions resulted in DASS symptom improvement at a median follow-up of 15 days. Patients with steal intervention had 60% lower odds of follow-up surgery (OR, 0.4; P = .007). There was no difference in major adverse events (P = .98) or access preservation (P = .13) between groups. CONCLUSIONS In this retrospective cohort study, approximately half of DASS fistulograms revealed a percutaneously treatable cause of steal. Over half of DASS interventions resulted in symptomatic relief. Percutaneous intervention was associated with lower odds of follow-up surgery without compromising access preservation.
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Affiliation(s)
- Devyn C Rigsby
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy W I Clark
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ansar Z Vance
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Chittams
- Biostatistics Consulting Unit, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Raphael Cohen
- Department of Medicine, Division of Renal, Electrolyte, and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark P Mantell
- Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Sidney Kobrin
- Department of Medicine, Division of Renal, Electrolyte, and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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2
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Higgins MCSS, Diamond M, Mauro DM, Kapoor BS, Steigner ML, Fidelman N, Aghayev A, Chamarthy MRK, Dedier J, Dillavou ED, Felder M, Lew SQ, Lockhart ME, Siracuse JJ, Dill KE, Hohenwalter EJ. ACR Appropriateness Criteria® Dialysis Fistula Malfunction. J Am Coll Radiol 2023; 20:S382-S412. [PMID: 38040461 DOI: 10.1016/j.jacr.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
The creation and maintenance of a dialysis access is vital for the reduction of morbidity, mortality, and cost of treatment for end stage renal disease patients. One's longevity on dialysis is directly dependent upon the quality of dialysis. This quality hinges on the integrity and reliability of the access to the patient's vascular system. All methods of dialysis access will eventually result in dialysis dysfunction and failure. Arteriovenous access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfunction, and infectious complications. The restoration of any form of arteriovenous access dysfunction may be supported by diagnostic imaging, clinical consultation, percutaneous interventional procedures, surgical management, or a combination of these methods. This document provides a rigorous evaluation of how variants of each form of dysfunction may be appraised and approached systematically. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Matthew Diamond
- Research Author, Boston Medical Center, Boston, Massachusetts
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | - Nicholas Fidelman
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Ayaz Aghayev
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Murthy R K Chamarthy
- Vascular Institute of North Texas, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Julien Dedier
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | - Ellen D Dillavou
- WakeMed Hospital System, Raleigh, North Carolina; Society for Vascular Surgery
| | - Mila Felder
- Advocate Christ Medical Center, Oak Lawn, Illinois; American College of Emergency Physicians
| | - Susie Q Lew
- George Washington University, Washington, District of Columbia; American Society of Nephrology
| | | | - Jeffrey J Siracuse
- Boston University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| | - Eric J Hohenwalter
- Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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3
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Chorney MA, Marino AG, Perez Lozada JCL. Ischemic Monomelic Neuropathy after Percutaneous Arteriovenous Fistula Creation. J Vasc Interv Radiol 2021; 32:624-626. [PMID: 33483227 DOI: 10.1016/j.jvir.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/26/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Michael A Chorney
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520
| | - Angelo G Marino
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520
| | - Juan Carlos L Perez Lozada
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520
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4
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Teixeira G, Almeida P, Loureiro L, Antunes I, Rego D, Teixeira S, Mendes D, Sousa CN, Queirós J, de Matos N, Almeida R. Arterial percutaneous angioplasty in hemodialysis access: Endovascular treatment of hand ischemia. J Vasc Access 2020; 22:411-416. [PMID: 32723132 DOI: 10.1177/1129729820946654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hemodialysis access-induced distal ischemia consists of symptomatic extremity malperfusion after vascular access creation. It is usually caused by discordant vascular resistance, with arteriovenous shunting of a high blood volume from arterial into venous system and subsequent hand hypoperfusion. Less often, hemodialysis access-induced distal ischemia is caused by arterial stenosis. In these cases, access frequently has normal/low flow, radial pulse is usually absent and not recoverable with vascular access digital compression, diabetes is often present, and percutaneous transluminal angioplasty can be critical for access and limb salvage. METHODS Retrospective study conducted between June 2011 and February 2018 of patients with vascular access submitted to arterial percutaneous transluminal angioplasty for limb-threatening ischemia. RESULTS Twenty-nine patients were referred for arterial angiography after hemodialysis access-induced distal ischemia diagnosis and physical examination or ultrasound findings suggestive of arterial disease. In 11 patients, percutaneous transluminal angioplasty was not technically feasible. Among 18 treated patients, 83.3% had diabetes and 60% had skin ulcerations. Target arteries were radial (11), brachial (7), axillar (2), ulnar (2), and subclavian (1). Clinical success, defined as arteriovenous maintenance and wound healing/pain resolution, was observed in 12 patients (66.7%). Concomitant procedures included adjuvant banding (n = 2) and finger amputation (n = 1), and one reintervention was performed. No intra- or postoperative complications were reported. CONCLUSION Hemodialysis access-induced distal ischemia is a serious complication of hemodialysis vascular access, with multifactorial etiology. Correct and timely diagnosis is crucial for maintaining access and limb salvage. Percutaneous transluminal angioplasty is a minimally invasive procedure that may be effective and long-lasting in carefully selected patients with ischemic complaints.
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Affiliation(s)
- Gabriela Teixeira
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Paulo Almeida
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Luís Loureiro
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Antunes
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Duarte Rego
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Sérgio Teixeira
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Daniel Mendes
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Clemente N Sousa
- Nursing School of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Faculty of Medicine, Porto University, Porto, Portugal
| | - José Queirós
- Department of Nephrology, Centro Hospitalar do Porto, Porto, Portugal
| | - Norton de Matos
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Rui Almeida
- Department of Angiology and Vascular Surgery, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
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5
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Salman L, Asif A. New Horizons in Dialysis Access: Approach to Hand Ischemia. Adv Chronic Kidney Dis 2020; 27:208-213. [PMID: 32891304 DOI: 10.1053/j.ackd.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/11/2022]
Abstract
Hand ischemia is a relatively common complication of hemodialysis arteriovenous (AV) access. Clinical manifestations frequently start with pale and cold ipsilateral hand. Symptoms can progress to pain during dialysis and can eventually lead to tissue necrosis and gangrene if not addressed in a timely fashion. Comprehensive physical examination of the hand, AV access, and comparing it with the contralateral hand will assist in differentiating hand ischemia from carpal tunnel syndrome, osteoarthritis of the hand, and others. There are several treatment options for hand ischemia based on the severity of symptoms. Conservative management with careful monitoring can be applied in early stages. However, if symptoms persist or worsen, a full arteriogram of the ipsilateral extremity should be performed to evaluate for the presence of arterial stenosis. Angioplasty of the arterial stenosis, if present, will frequently lead to the resolution of symptoms. There are several percutaneous and surgical treatment options for hand ischemia, if no arterial stenosis was found or angioplasty does not relieve symptoms. We discuss in this article these treatment options in detail. Treatment goal is to improve hand ischemia symptoms while maintaining hemodialysis AV access and preserving patient's hand. Access ligation remains a treatment of last resort.
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Odajima S, Inoue T, Hamana T, Masaki R, Fujimoto W, Kuroda K, Hatani Y, Iwasaki M, Okamoto H, Okuda M, Hayashi T. Skin ulcer due to hemodialysis access-induced distal ischemia treated with arteriovenous fistula banding and endovascular therapy. J Cardiol Cases 2019; 20:155-157. [PMID: 31719933 DOI: 10.1016/j.jccase.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/05/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022] Open
Abstract
A 58-year-old woman with pallor on her left hand due to chronic hemodialysis presented with a recent intractable skin ulcer on her left 3rd finger; the skin perfusion pressure (SPP) was 19 mmHg. Preoperative angiography revealed an occluded proximal left radial artery, no communication between the ulnar and superficial palmar arteries, several collaterals from the left ulnar to the radial artery, and no visualization of the finger arteries. Successful endovascular therapy to the occluded radial artery increased flow to the arteriovenous fistula (AVF), but not to the fingertips. Slightly compressing the AVF augmented the flow and wound blush at the wound sites on the 3rd fingertip, leading to a diagnosis of hemodialysis access-induced distal ischemia (HAIDI). Surgical AVF banding with intra-operative SPP monitoring improved the SPP to 34 mmHg, leading to complete wound healing over 1 month with a preserved AVF. We performed a bilateral temporal artery biopsy and diagnosed giant cell arteritis. As the angiographic wound blush at wound sites is reportedly an important factor for wound healing, angiography with AVF manual compression is essential to diagnose HAIDI and evaluate the blood flow for wound healing. <Learning objective: Hemodialysis access-induced distal ischemia (HAIDI) is a potentially devastating complication of an arteriovenous fistula (AVF). As it is difficult to diagnose, it may necessitate major amputation. The angiographic wound blush is related to wound healing, making angiography an essential modality for evaluating blood flow in HAIDI, especially in case of an ischemic intractable ulcer. Angiography with AVF manual compression is not only essential to diagnose HAIDI, but also effective to evaluate the flow for wound healing.>.
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Affiliation(s)
- Susumu Odajima
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Takumi Inoue
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Tomoyo Hamana
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Ryota Masaki
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Wataru Fujimoto
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Koji Kuroda
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Yutaka Hatani
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Masamichi Iwasaki
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Hiroshi Okamoto
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Masanori Okuda
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
| | - Takatoshi Hayashi
- Hyogo Prefectural Awaji Medical Center, Cardiovascular Medicine, 1-1-137 Shioya, Sumoto, Hyogo 656-0021, Japan
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7
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Chen JX, Levin LS, Mantell MP, Redmond JW, Clark TWI. Endovascular Therapy for Below-the-Elbow Arterial Disease: An Initial Single-Center Experience. J Endovasc Ther 2019; 26:505-511. [PMID: 31179815 DOI: 10.1177/1526602819854167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the technical success, clinical success, and complication rates of endovascular revascularization for below-the-elbow (BTE) peripheral artery disease. Materials and Methods: A retrospective review was performed of 19 patients (mean age 63 years; 12 men) with critical hand ischemia (CHI) who underwent 25 interventions in 19 arms between October 2010 and June 2017. Access was attained using 4-F or 5-F sheaths via antegrade brachial, retrograde radial, or fistula/graft access routes depending on the target vessel. A 0.018-inch hydrophilic microwire was used for intimal or subintimal recanalization. Angioplasty was performed over a 0.014-inch guidewire using low-profile balloons. The primary endpoint of the study was technical success, defined as successful lesion crossing/dilation, with residual stenosis <30%. Clinical success referred to improvement in pain and/or steal symptoms. Results: Technical success was achieved in 88% (22 of 25 procedures), with no significant difference in outcome associated with indications or baseline vessel disease. Complications occurred in 6 cases, of which 5 were minor and 1 was major. Clinical success was achieved in 12 of 14 patients with available follow-up; 5 of 7 patients with ulcers experienced wound healing. Conclusion: Endovascular revascularization for BTE occlusive disease is an effective and safe strategy for treating CHI.
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Affiliation(s)
- James X Chen
- 1 Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,2 Vascular and Interventional Specialists, Charlotte Radiology, Charlotte, NC, USA
| | - L Scott Levin
- 3 Department of Orthopedic Surgery and Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark P Mantell
- 4 Division of Vascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonas W Redmond
- 1 Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy W I Clark
- 1 Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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8
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Cheun TJ, Jayakumar L, Sideman MJ, Pounds LL, Davies MG. Upper extremity arterial endovascular interventions for symptomatic vascular access-induced steal syndrome. J Vasc Surg 2019; 70:1896-1903.e1. [PMID: 31126767 DOI: 10.1016/j.jvs.2019.01.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Critical hand ischemia owing to vascular access-induced steal syndrome (VASS) continues to be a significant problem. The aim of this study was to examine the outcomes of arterial endovascular interventions in the upper extremity of patients presenting with VASS. METHODS A database of patients presenting with documented VASS between 2006 and 2016 was retrospectively queried. Patients who underwent isolated endovascular intervention in the upper extremity were analyzed. RESULTS Ninety-eight patients (66% female; average age 65 years) presented with VASS: 28 presented with upper arm atherosclerotic disease above the arteriovenous (AV) anastomosis (above elbow) and the remaining 70 patients with below AV anastomotic atherosclerotic disease at the elbow (below elbow). Sixty-three percent of the entire patient cohort (N = 65) presented with rest pain and the remainder (n = 33 [34%]) with minor digital ulceration. Of those with upper arm disease above the AV anastomosis, one-third of patients had subclavian occlusive disease and two-thirds had brachial artery occlusive disease. Patients with subclavian disease underwent stent placement, and patients with brachial artery disease underwent balloon angioplasty. Technical success was 100% (n = 28). Ninety-one percent of these patients (n = 25) had symptomatic success at 30 days and the remainder (n = 3) required proximalization of the access. Of those with below AV anastomosis at the elbow disease, all had disease in the forearm vessels with 42% (n = 29) having either the ulnar or radial artery occlusion. Balloon angioplasty was performed in one vessel in 55% (n = 38) and in two vessels in 45% (n = 32) of patients. Technical success was 79% (n = 81 of 102 vessels) with 51% of the patients (n = 36) having symptomatic success at 30 days; of those who remained symptomatic, 80% (n = 27) required proximalization of the access and 20% (n = 7) required ligation. The major adverse cardiovascular event rate for the entire patient cohort was 4% (n = 4). The 30-day complications for the entire patient cohort included continued steal (38%; all resolved with secondary procedures), thrombosis (3%; all forearm vessels treated for occlusion), bleeding (0%), infection (0%), and mortality (1%). Primary clinical success defined as the relief of distal ischemic symptoms and the preservation of a functional access site for dialysis showed rates of 42 ± 9% (mean ± standard error of the mean) and 0 ± 0% at 5 years (above and below elbow groups, respectively). CONCLUSIONS Upper extremity interventions for VASS owing to above elbow disease are associated with a high rate of success, whereas interventions for below elbow disease have a poor clinical success with more patients requiring secondary procedures and low long-term survival for the access site. Male patients presenting with rest pain, larger forearm vessels (approximately 3 mm), short occlusive lesions (<100 mm), two-vessel runoff, and an intact palmer arch are good candidates for below elbow interventions.
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Affiliation(s)
- Tracy J Cheun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, Tex
| | - Lalithapriya Jayakumar
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, Tex
| | - Matthew J Sideman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, Tex
| | - Lori L Pounds
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, Tex
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Tex; South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, Tex.
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9
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Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrologia 2018; 37 Suppl 1:1-191. [PMID: 29248052 DOI: 10.1016/j.nefro.2017.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.
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10
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Miller G, Khariton K, Kardos S, Koh E, Goel N, Khariton A. Flow Interruption of the Distal Radial Artery: Treatment for Finger Ischemia in a Matured Radiocephalic AVF. J Vasc Access 2018. [DOI: 10.1177/112972980800900110] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose To establish an effective approach for diagnosis and treatment of hand ischemia in matured radiocephalic arteriovenous fistulae (AVF). Methods One hundred and fifty end-stage renal disease patients (4% of our practice) presented to our outpatient vascular access facility complaining of a range of symptoms including coldness, numbness and pain in the fingers indicative of ischemia due to steal syndrome. In 15 patients the symptoms of steal syndrome were limited to the fingers, sparing the hand. Physical examination was indicative of steal syndrome caused by shunting of blood from the ulnar artery via the palmar arch, away from the fingers and into the fistula. To confirm the diagnosis, angiography was performed which demonstrated retrograde flow in the distal radial artery (DRA), a hypertrophied palmar arch, and a patent hypertrophied ulnar artery. Ischemia was treated with DRA flow interruption. Transcatheter coil embolization of the DRA (10 patients) was preferred because it proved to be a quick, safe and effective technique. Whenever embolization was not possible ligation of the DRA was performed in accordance with accepted surgical literature (five patients). Results DRA flow interruption was effectively accomplished by either ligation or coil embolization in all cases. All patients had symptomatic improvement. Complete symptom resolution was experienced by 100% (10/10) of patients who received DRA embolization and by 3/5 patients who required ligation. The average follow-up period was 9 months. There were no complications during the procedure or during the follow-up period. Conclusion Diagnosis using physical examination, angiography and treatment with embolization or ligation of the DRA can be performed with great success in an outpatient setting.
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Affiliation(s)
- G.A. Miller
- American Access Care of Brooklyn, New York - USA
| | - K. Khariton
- American Access Care of Brooklyn, New York - USA
| | - S.V. Kardos
- American Access Care of Brooklyn, New York - USA
| | - E. Koh
- American Access Care of New Jersey, New York - USA
| | - N. Goel
- American Access Care of Florida, Plantation FL - USA
| | - A. Khariton
- American Access Care of Brooklyn, New York - USA
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11
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Bui J, Gaba R, Knuttinen M, West D, Owens C. Amplatzer Vascular Plug for Arteriovenous Hemodialysis Access Occlusion: Initial Experience. J Vasc Access 2018; 10:5-10. [DOI: 10.1177/112972980901000102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose The Amplatzer Vascular Plug (AVP; AGA Medical, Golden Valley, MN) is a recently developed self-expanding metallic device indicated for peripheral vascular embolizations. Herein, we describe use of this device in the treatment of vascular complications related to arteriovenous hemodialysis fistulas and grafts. Materials and methods This HIPAA compliant retrospective study was approved by the institutional review board with informed consent waived. Six patients with problematic arteriovenous access underwent access occlusion using the AVP. Procedure indications included vascular steal syndrome in five patients, and enlarging vascular aneurysms in one patient. Contraindications for surgical correction were determined by the referring surgeon. AVP embolizations were performed using devices oversized by 50% introduced through vascular sheaths positioned within vein segments just beyond the arteriovenous anastomoses. Noninvasive evaluation of the involved extremity was performed pre- and post-embolization in addition to clinical follow-up examinations. Measured outcomes included success of angiographic occlusion, improvement in distal arterial flow, AVP number, AVP diameter, time to access occlusion, and clinical symptomatic improvement. Results Technical success was 100%, with complete arteriovenous access occlusion accomplished in all cases, with an average of 1.5 AVPs used per patient. Mean time to access occlusion was 19.3 minutes. Angiographic improvement in distal arterial flow was immediately evident and resolution of clinical symptoms occurred in all patients, with mean long-term follow-up of 16 months. No procedure-related complications were encountered. Conclusion The Amplatzer Vascular Plug provides a minimally invasive and efficacious method for embolization of problematic arteriovenous hemodialysis access.
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Affiliation(s)
- J.T. Bui
- Department of Radiology, University of Illinois Medical Center at Chicago, Chicago, IL - USA
| | - R.C. Gaba
- Department of Radiology, University of Illinois Medical Center at Chicago, Chicago, IL - USA
| | - M.G. Knuttinen
- Department of Radiology, University of Illinois Medical Center at Chicago, Chicago, IL - USA
| | - D.L. West
- Department of Radiology, University of Illinois Medical Center at Chicago, Chicago, IL - USA
| | - C.A. Owens
- Department of Radiology, University of Illinois Medical Center at Chicago, Chicago, IL - USA
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12
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Henriksson AE, Bergqvist D. Steal Syndrome of the Hemodialysis Vascular Access: Diagnosis and Treatment. J Vasc Access 2018; 5:62-8. [PMID: 16596543 DOI: 10.1177/112972980400500204] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Steal syndrome is an uncommon but serious condition of arterial insufficiency distal to a permanent hemodialysis fistula. The management of the condition is a great challenge to the surgeon because of the conflicting goals of preserving the fistula and treat the ischemia. In this review the purpose was to analyze the clinical problem and treatment possibilities. Methods Medline and Embase databases were searched for studies relevant to diagnosis and management of steal syndrome of the hemodialysis vascular access. Results The diagnosis of steal syndrome is largely based on clinical features and non-invasive studies. In same cases angiography may be necessary to find out the real causes of the steal syndrome. The cause is usually high fistula flow but other causes as steal phenomenon, inflow, outflow or anastomotic stenosis have to be considered and even combination of causes. The main treatment options are some form of flow reducing procedure or the distal revascularization interval ligation method. In some cases simple distal arterial ligation is the method of choice. Furthermore, in some patients a stenosis has to be treated as the first treatment option. Conclusion For an appropriate treatment of a steal syndrome a careful analysis of the cause is important.
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Affiliation(s)
- A E Henriksson
- Department of Surgery, Sundsvall County Hospital, Sweden.
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13
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Kamyar MM, Saeed Modaghegh MH, Kazemzadeh G. Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients. Semin Vasc Surg 2017; 29:172-177. [PMID: 28779783 DOI: 10.1053/j.semvascsurg.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Placement of autogenous arteriovenous fistula (AVF) is one of the basic needs in hemodialysis patients. Although many studies have investigated the complications of AVF placement, the complaints expressed by patients have not been studied in a long-term study. The purpose of this study was to evaluate the incidence of complaints after placement of autogenous AVF in patients undergoing chronic hemodialysis. This cohort study was conducted on patients with end-stage renal disease undergoing AVF placement who were referred to Imam Reza hospital in Mashhad, Iran, from January 2015 to June 2016. The AVFs were placed in all patients and incidence rates of expressed complaints, including pain, paresthesia, and edema, were assessed up to three periods 1 month after surgery and three periods 2 months after starting use of the AVF. Data were analyzed using SPSS software, version 19. The relationship of AVF types with each of the outcomes was analyzed via χ2 test. Three hundred and eighty-eight patients (222 males and 166 females; mean age 54.3 ± 16.0 years) were studied. AVF was established in the cubital site of 230 patients, in snuff box of 103 patients, and distal forearm of 55 patients. Total incidence rate of pain within six follow-up periods and incidence rates of paresthesia and edema were determined as 18.1%, 2.6%, and 5.4%, respectively. A statistically significant relationship was observed between types of AVF and pain and paresthesia (P < .05). According to results from this study, pain and then edema were the most common complaints, followed by AVF placement in the patients. Paresthesia had lower incidence rates compared to other complaints.
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Affiliation(s)
- Mohammad Mahdi Kamyar
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran
| | - Mohammad Hadi Saeed Modaghegh
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran
| | - Gholamhossein Kazemzadeh
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran.
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14
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McArdle DJT, Cottier D, Beasley A. Digital ischaemia secondary to steal syndrome from a brachiocephalic arteriovenous fistula. BMJ Case Rep 2016; 2016:bcr-2016-217323. [PMID: 27613268 DOI: 10.1136/bcr-2016-217323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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15
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Pomper SR, Huie FJ, Shalashov A, Kopatsis A. Correction of Steal Syndrome from Hemoaccess with Pulse Oximetry Assistance. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857440003400617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are many techniques described for the correction of steal syndrome. Most of these techniques use subjective criteria to evaluate the return of blood flow to the extremity. This article describes a simple technique to give an objective measurement of blood flow to the extremity. Pulse oximetry was used to help establish return of blood flow to the hand and give an objective endpoint for banding. Both patients had subjective and objective correction of the steal syndrome after surgery.
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Affiliation(s)
| | | | | | - Anthony Kopatsis
- Department of Surgery, Staten Island University Hospital, Staten Island, New York
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16
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Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula. Cardiovasc Intervent Radiol 2016; 39:1266-71. [PMID: 27224985 DOI: 10.1007/s00270-016-1368-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses. METHOD The cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery. RESULTS Of 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41-78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery. CONCLUSION In palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.
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17
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Law Y, Chan YC, Cheng SWK. Angioplasty of forearm arteries as a finger salvage procedure for patient with end-stage renal failure. Int J Nephrol Renovasc Dis 2016; 9:105-9. [PMID: 27143949 PMCID: PMC4846062 DOI: 10.2147/ijnrd.s102257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Due to the relatively low metabolic demand and extensive collaterals of the upper limb, peripheral arterial disease seldom leads to tissue loss, except in patients with end-stage renal failure (ESRF), rheumatologic diseases, Raynaud's disease, frostbites, or distal emboli. We report a case of a 51-year-old lady with ESRF who presented to our tertiary referral vascular center with infected gangrene of her right ring finger. Duplex ultrasound showed that her forearm arteries were severely diseased. Digital subtraction angiogram showed severe multilevel stenoses/occlusions in her forearm radial and ulnar arteries. These lesions were successfully angioplastized with 2 mm × 25 mm angioplasty balloon. Completion angiogram showed good radiological results with some post-dilatation spasm which improved with intra-arterial glyceryl trinitrate. The sepsis improved after revascularization, and the distal phalanx was allowed to self-demarcate with dressings and autoamputate with good clinical results. Our case illustrated that even in delayed setting, patients could still benefit from specialist vascular care with a combination of expert care and angioplasty of forearm arteries, with successful salvage of her finger.
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Affiliation(s)
- Yuk Law
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen Wing-Keung Cheng
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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18
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Kukita K, Ohira S, Amano I, Naito H, Azuma N, Ikeda K, Kanno Y, Satou T, Sakai S, Sugimoto T, Takemoto Y, Haruguchi H, Minakuchi J, Miyata A, Murotani N, Hirakata H, Tomo T, Akizawa T. 2011 update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis. Ther Apher Dial 2015; 19 Suppl 1:1-39. [PMID: 25817931 DOI: 10.1111/1744-9987.12296] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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19
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Yevzlin AS, Chan MR, Asif A. Hand Ischemia in a Patient With an Arteriovenous Fistula. Am J Kidney Dis 2015; 67:512-5. [PMID: 26612279 DOI: 10.1053/j.ajkd.2015.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/31/2015] [Indexed: 11/11/2022]
Abstract
An ischemic digit causes significant morbidity due to its associated discomfort and potential for tissue necrosis. Historically, when this phenomenon was peripheral to an ipsilateral arteriovenous access in a hemodialysis patient, it was called "steal syndrome" and was usually treated with access ligation, resulting in loss of the access. We present a dialysis patient with hand pain due to ischemia that was referred for access ligation. Instead, a minimally invasive banding procedure was performed that resulted in access salvage and resolution of symptoms. We present images and a discussion of the diagnosis and treatment of distal hypoperfusion ischemia syndrome in this Imaging Teaching Case.
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Affiliation(s)
- Alexander S Yevzlin
- Interventional Nephrology, Division of Nephrology, University of Wisconsin, Madison, WI.
| | - Micah R Chan
- Interventional Nephrology, Division of Nephrology, University of Wisconsin, Madison, WI
| | - Arif Asif
- Interventional Nephrology, Division of Nephrology, Albany Medical Center, Albany, NY
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20
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Intervention for Access-Induced Ischemia: Which Option is the Best? J Vasc Access 2015; 16 Suppl 9:S102-7. [DOI: 10.5301/jva.5000338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Access-induced ischemia is a rare but important surgical complication with potentially devastating long-term results. The question remains which therapeutic option is the best for the different forms of ischemia. Method A review of the literature concerning access-induced ischemia (classification, treatment) was performed; furthermore, our own experience of more than 300 cases with ischemia was discussed. Results There are four different stages of dialysis access-induced ischemia syndrome (DAIIS) that need adequate treatment: stage I conservatively, stage II fistula banding, stage III proximalization operation or distal revascularization interval ligation and stage IV closure of the access. Discussion According to the many publications and to our own experience, there are good therapeutic options for many of the patients with DAIIS. However, in case of extended lesions/gangrene, closure of the access should be discussed in time before major amputation becomes necessary.
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21
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Peeters K, Heye S, Dewever L, Claes K, Fourneau I. Hemodialysis access-induced ischemia is not related to configuration and access flow rates of upper arm arteriovenous fistulas at the elbow. Ann Vasc Surg 2015; 29:682-9. [PMID: 25656688 DOI: 10.1016/j.avsg.2014.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of the study was to find a relationship between the configuration of autogenous upper arm arteriovenous fistulas (AVFs) at the elbow and high access flow rates. METHODS Forty-seven patients with well-functioning autogenous upper arm AVFs at the elbow were included. The configuration of the AVF and access flow rate was determined by duplex scanning. RESULTS Hemodialysis access-induced distal ischemia scores and access flow rates were comparable in AVFs with 1 or 2 efferent veins (1829.9 ± 1121.3 mL/min, range [400-5000] vs. 1988.5 ± 1324.5 mL/min, range [130-5000]; P = 0.61). The basilic vein had statistically significant larger diameters than the cephalic vein (8.1 ± 2.7 mm, range [2.7-11.0] vs. 5.8 ± 2.5 mm, range [3.8-13.0]; P = 0.02), but no statistically significant difference in flow rates were observed (1884.5 ± 889.0 mL/min, range [824-3600] vs. 1130.0 ± 1258.4 mL/min, range [400-5000]; P = 0.53). Access flow rates were higher in AVFs with the brachial artery as afferent artery than when the radial artery was used (1909.5 ± 1273.2 mL/min, range [550-5000] vs. 1188.6 ± 642.7 mL/min, range [130-2800]; P = 0.02). CONCLUSIONS There is no difference in access flow rates in autogenous AVFs at the elbow with 1 or 2 efferent veins. Autogenous AVFs at the elbow on the radial artery have lower access flow rates than AVFs on the brachial artery.
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Affiliation(s)
- Karen Peeters
- Department of Vascular Surgery, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Sam Heye
- Department of Radiology, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth Dewever
- Department of Radiology, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Claes
- Department of Nephrology, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium.
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22
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Kawarada O, Sakamoto S, Harada K, Noguchi T, Ogawa H, Yasuda S. Below-the-elbow intervention for Buerger's disease. Cardiovasc Interv Ther 2014; 30:385-9. [PMID: 25547258 DOI: 10.1007/s12928-014-0312-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/17/2014] [Indexed: 11/26/2022]
Abstract
An increasing attention has been paid to endovascular therapy for lower limb ischemia in patients with Buerger's disease. However, critical hand ischemia in Buerger's disease patients has been underappreciated despite a tremendous advancement of endovascular therapy for peripheral arterial disease. Herein, we describe endovascular "hand" salvage with a below-the-elbow intervention.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Shingo Sakamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Koichiro Harada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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23
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Treatment of hemodialysis vascular access arteriovenous graft failure by percutaneous intervention. J Vasc Access 2014; 15 Suppl 7:S114-9. [PMID: 24817467 DOI: 10.5301/jva.5000234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 02/05/2023] Open
Abstract
A patent vascular access is the lifeline of end-stage renal disease patients depending on hemodialysis treatment. Once a functioning vascular access has been established, maintaining its patency is of utmost importance. During the last decades percutaneous techniques became increasingly important for the treatment of hemodialysis vascular access graft failure. In this review, the role of percutaneous balloon angioplasty and stent implantation is evaluated for different clinical scenarios, based on the available evidence.
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24
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De Caridi G, Massara M, Benedetto F, Tripodi P, Spinelli F, David A, Grande R, Butrico L, Serra R, de Franciscis S. Adjuvant spinal cord stimulation improves wound healing of peripheral tissue loss due to steal syndrome of the hand: clinical challenge treating a difficult case. Int Wound J 2014; 13:72-6. [PMID: 24533915 DOI: 10.1111/iwj.12233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/12/2014] [Indexed: 12/13/2022] Open
Abstract
Hand ischaemia due to arterial steal syndrome is an infrequent, but potentially serious complication of arteriovenous fistula (AVF) for haemodialysis. We present a case of hand ischaemia caused by steal syndrome in a 69-year-old haemodialysis patient, 10 months after a brachiobasilic fistula creation. The patient underwent multiple operations without resolution of hand pain and tissue loss. The implantation of an adjuvant cervical spinal cord stimulator allowed the patient to obtain complete hand pain relief and wound healing. Probably, the diffuse microangiopathy typical of haemodialysis patients could be responsible for the persistence of ischaemic signs and symptoms after a surgical revascularisation. The effect of sympathetic blockade and the subsequent improvement of the arterial blood flow and tissue oxygenation because of spinal cord stimulation (SCS) can be useful to achieve complete ischaemic pain relief in order to enhance wound healing and to limit the tissue loss. In conclusion, the association of cervical spinal cord stimulation and surgical revascularisation could represent a valid option to treat a critical upper limb ischaemia following steal syndrome due to AVF.
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Affiliation(s)
- Giovanni De Caridi
- Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy
| | - Mafalda Massara
- Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy
| | - Filippo Benedetto
- Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy
| | - Paolo Tripodi
- Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy
| | - Francesco Spinelli
- Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy
| | - Antonio David
- Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy
| | - Raffaele Grande
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Lucia Butrico
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
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25
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Beathard GA, Spergel LM. Hand Ischemia Associated With Dialysis Vascular Access: An Individualized Access Flow-based Approach to Therapy. Semin Dial 2013; 26:287-314. [DOI: 10.1111/sdi.12088] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gerald A. Beathard
- University of Texas Medical Branch and Lifeline Vascular Access; Houston; Texas
| | - Lawrence M. Spergel
- Department of Surgery; Davies Medical Center; and the Dialysis Management Medical Group; San Francisco; California
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26
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Side branch ligation for haemodialysis-access-induced distal ischaemia. Eur J Vasc Endovasc Surg 2012; 44:452-6. [PMID: 22867748 DOI: 10.1016/j.ejvs.2012.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/12/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Chronic hand ischaemia is occasionally observed in haemodialysis patients with a brachiocephalic fistula using the Gracz technique. Open venous side branches of the access may contribute to lower peripheral perfusion pressures. This study reports on the effects of access side branch ligation (SBL) on ischaemia in patients with haemodialysis access induced distal ischaemia (HAIDI). DESIGN, MATERIALS AND METHODS Hand ischaemia was quantified using a published questionnaire (HIQ, minimal 0 points: no ischaemia, maximal 500: excruciating ischaemia). Finger pressures (P(dig), mmHg), digital brachial index (DBI) and access flow were measured before and after SBL. RESULTS Twenty-two patients were operated for grade 2-4 HAIDI during 7 years, and 12 underwent SBL (as single procedure n = 5, preceeding banding/DRIL n = 7). Hand ischaemia was attenuated after SBL only (n = 5, HIQ 216 ± 39 vs. 73 ± 26, P = 0.04). A 25% increase was observed in both P(dig) (n = 12, before SBL: 57 ± 8 mmHg, after: 72 ± 8 mmHg, P = 0.012) and DBI (before SBL: 0.49 ± 0.06, after: 0.61 ± 0.04, P = 0.006). Access flow did not change. All patients successfully resumed dialysis. CONCLUSION SBL may be effective as single or adjunctive surgical procedure in the treatment of HAIDI in the presence of a Gracz fistula.
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27
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Scheltinga M, Bruijninckx C. Haemodialysis Access-induced Distal Ischaemia (HAIDI) is Caused by Loco-regional Hypotension but not by Steal. Eur J Vasc Endovasc Surg 2012; 43:218-23. [DOI: 10.1016/j.ejvs.2011.10.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/23/2011] [Indexed: 11/24/2022]
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28
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Ferraresi R, Palloshi A, Aprigliano G, Caravaggi C, Centola M, Sozzi F, Danzi G, Manzi M. Angioplasty of Below-the-elbow Arteries in Critical Hand Ischaemia. Eur J Vasc Endovasc Surg 2012; 43:73-80. [DOI: 10.1016/j.ejvs.2011.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
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29
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Novel strategy for percutaneous transluminal angioplasty for complex critical hand. Cardiovasc Interv Ther 2011; 27:52-6. [DOI: 10.1007/s12928-011-0079-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 08/25/2011] [Indexed: 11/25/2022]
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30
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Intra-arterial thrombolysis of acute hand ischaemia with or without microcatheter: preliminary experience and comparison with the literature. Radiol Med 2011; 116:919-31. [DOI: 10.1007/s11547-011-0681-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
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31
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Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review. J Vasc Access 2011; 12:113-9. [DOI: 10.5301/jva.2011.6365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2010] [Indexed: 11/20/2022] Open
Abstract
The creation of a vascular access for hemodialysis is a frequently performed procedure. Ischemic monomelic neuropathy (IMN) is a rare, but important complication of hemodialysis access (HA) procedures, which can lead to severe and nonreversible limb dysfunctions. Therefore, in any case of postoperative neurological malfunction, immediate neurological investigations should be undertaken. If IMN is diagnosed, improvement of distal perfusion should be established without delay. IMN is a form of hemodialysis-associated ischemic syndrome (as the so-called steal syndrome), but experiences with this complication are small. Every case of IMN should be carefully documented and if possible published, to gain more experience about this rare but important complication.
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32
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Kawarada O, Yokoi Y, Higashimori A. Angioplasty of ulnar or radial arteries to treat critical hand ischemia: use of 3- and 4-French systems. Catheter Cardiovasc Interv 2011; 76:345-50. [PMID: 20839345 DOI: 10.1002/ccd.22545] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this preliminary study is to report the results of catheter-based treatment for isolated distal upper extremity artery disease with CHI. BACKGROUND Critical hand ischemia (CHI) is a rare but potentially devastating condition. METHODS The study consisted of five critically ischemic hands (Rutherford category 4: 2, Rutherford category 5: 3) in four patients undergoing catheter intervention for isolated distal upper extremity artery disease between November 2007 and April 2009. RESULTS Balloon angioplasty via an antegrade brachial approach was performed with a 3Fr or 4Fr sheath to achieve the principal endpoint of the establishment of one straight-line flow to the palmar arch. All patients had end-stage renal disease requiring chronic hemodialysis. The target vessels were the ulnar artery in four cases, the radial artery in one, and the palmar arch in two. Four cases had a stenotic lesion and one had chronic total occlusion. Technical success was achieved in all cases without complications, and skin perfusion pressure of the hand improved significantly from 39 ± 20 to 52 ± 16 (P = 0.019) on the palmar side and from 40 ± 18 to 60 ± 29 on the dorsal side (P = 0.046). Clinical success was achieved in all cases during a mean follow-up period of 11 ± 8 (2-19) months. CONCLUSIONS Percutaneous angioplasty using contemporary dedicated devices could be a potentially useful option for CHI patients with isolated distal upper extremity artery disease.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada-City, Osaka, Japan.
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Simple and Durable Resolution of Steal Syndrome by Conversion of Brachial Artery Arteriovenous Fistulas to Proximal Radial Artery Inflow. J Vasc Access 2010; 11:352-5. [DOI: 10.5301/jva.2010.2492] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dialysis associated steal syndrome (DASS) is relatively uncommon but constitutes a serious risk for patients undergoing vascular access operations. We report two patients with DASS where brachial artery vascular access inflow was revised to the proximal radial artery for arteriovenous fistula (AVF) inflow. DASS was resolved in both patients with the permanent resolution of symptoms, in addition to the healing of ulcerations and ischemia. Both AVFs were immediately functional and durable.
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Zamani P, Kaufman J, Kinlay S. Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis. Vasc Med 2009; 14:371-6. [DOI: 10.1177/1358863x09102293] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract Arteriovenous fistulae in the arm are commonly used for hemodialysis in end-stage renal disease. Although physiological steal with reverse flow in the artery distal to the fistula is common, hand ischemia or infarction are rare. The ischemic steal syndrome (hand or forearm ischemia) is usually a result of arterial disease proximal or distal to the fistula and/or poor collateral supply to the hand. The diagnosis is primarily clinical; however, markedly reduced digital pressures and pulse volume recordings support the diagnosis. Management requires imaging for focal stenoses or disease in arteries proximal and distal to the fistula from the aorta to the hand. We present a case caused by subclavian artery occlusion that was initially missed due to focusing investigation only on the fistula. We describe the percutaneous treatments and surgical revisions that attempt to restore flow to the hand without compromising the fistula.
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Affiliation(s)
- Payman Zamani
- Cardiovascular Division, Veterans Affairs Boston Healthcare System and Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School
| | - James Kaufman
- Renal Division, Veterans Affairs Boston Healthcare System and Boston University School of Medicine
| | - Scott Kinlay
- Cardiovascular Division, Veterans Affairs Boston Healthcare System and Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School
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Asif A, Yevzlin AS. Arterial stent placement in arteriovenous dialysis access by interventional nephrologists. Semin Dial 2009; 22:557-60. [PMID: 19747177 DOI: 10.1111/j.1525-139x.2009.00623.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Arterial stenoses in patients with arteriovenous dialysis access can create a variety of problems including access dysfunction, thrombosis, and hand ischemia. While percutaneous balloon angioplasty is largely successful in the management of arterial stenoses, elastic recoil can present a real predicament to this treatment. In this report, we present two cases of arterial stenosis that demonstrated elastic recoil after angioplasty and required endovascular stent insertion. Both cases were treated successfully without any complications on an outpatient basis. This report describes arterial stent placement in patients with arteriovenous access and discusses anticoagulation considerations in such cases.
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Affiliation(s)
- Arif Asif
- Division of Nephrology, Section of Interventional Nephrology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
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Salman L, Maya ID, Asif A. Current concepts in the pathophysiology and management of arteriovenous access-induced hand ischemia. Adv Chronic Kidney Dis 2009; 16:371-7. [PMID: 19695505 DOI: 10.1053/j.ackd.2009.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The manifestations of hand ischemia because of an arteriovenous access can range from hand pain, tissue necrosis, and loss of the entire hand. Recent data have emphasized that multiple mechanisms (arterial steal, ie, retrograde flow, arterial stenosis, and arterial calcification) are responsible for inducing hand ischemia. Because any or a combination of the 3 mechanisms can lead to peripheral ischemia, distal hypoperfusion ischemic syndrome is a more appropriate term to denote hand ischemia. A detailed history, physical examination, and differential diagnosis form the initial step in the management of distal hypoperfusion ischemic syndrome. A complete arteriogram to evaluate the circulation of the extremity from the aortic arch to the palmar arch is essential. The choice of treatment modality should be based on this evaluation. In this article, we review the pathophysiology and present current strategies to ameliorate distal hypoperfusion ischemic syndrome.
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Yevzlin AS, Schoenkerman AB, Gimelli G, Asif A. Arterial Interventions in Arteriovenous Access and Chronic Kidney Disease: A Role for Interventional Nephrologists. Semin Dial 2009; 22:545-56. [DOI: 10.1111/j.1525-139x.2009.00626.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Raynaud A, Novelli L, Rovani X, Carreres T, Bourquelot P, Hermelin A, Angel C, Beyssen B. Radiocephalic Fistula Complicated by Distal Ischemia: Treatment by Ulnar Artery Dilatation. Cardiovasc Intervent Radiol 2009; 33:223-5. [DOI: 10.1007/s00270-009-9645-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 06/04/2009] [Accepted: 06/22/2009] [Indexed: 11/30/2022]
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Low-flow maturation failure of distal accesses: Treatment by angioplasty of forearm arteries. J Vasc Surg 2009; 49:995-9. [DOI: 10.1016/j.jvs.2008.10.061] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 10/24/2008] [Accepted: 10/27/2008] [Indexed: 11/18/2022]
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Hollenbeck M, Mickley V, Brunkwall J, Daum H, Haage P, Ranft J, Schindler R, Thon P, Vorwerk D. Gefäßzugang zur Hämodialyse. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11560-009-0281-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Plication as Primary Treatment of Steal Syndrome in Arteriovenous Fistulas. Ann Vasc Surg 2009; 23:103-7. [DOI: 10.1016/j.avsg.2008.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 08/03/2008] [Accepted: 08/05/2008] [Indexed: 11/21/2022]
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Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg 2008; 48:55S-80S. [PMID: 19000594 DOI: 10.1016/j.jvs.2008.08.067] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 08/09/2008] [Accepted: 08/18/2008] [Indexed: 02/07/2023]
Abstract
English language citations reporting complications of arteriovenous access for hemodialysis are critically reviewed and discussed. Venous hypertension, arterial steal syndrome, and high-output cardiac failure occur as a result of hemodynamic alterations potentiated by access flow. Uremic and diabetic neuropathies are common but may obfuscate recognition of potentially correctable problems such as compression or ischemic neuropathy. Mechanical complications include pseudoaneurysm, which may develop from a puncture hematoma, degeneration of the wall, or infection. Dysfunctional hemostasis, hemorrhage, noninfectious fluid collections, and access-related infections are, in part, manifestations of the adverse effects of uremia on the function of circulating hematologic elements. Impaired erythropoiesis is successfully managed with hormonal stimulation; perhaps, similar therapies can be devised to reverse platelet and leukocyte dysfunction and reduce bleeding and infectious complications.
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Affiliation(s)
- Frank T Padberg
- Department of Surgery, Section of Vascular Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, USA.
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Thermann F, Wollert U, Dralle H, Brauckhoff M. Dialysis Shunt-Associated Steal Syndrome with Autogenous Hemodialyis Accesses: Proposal for a New Classification Based on Clinical Results. World J Surg 2008; 32:2309-15. [DOI: 10.1007/s00268-008-9677-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Young GB, Bolton CF. Neurologic Complications of End-Stage Renal Disease: Peripheral Nervous System Complications in Hemodialysis Patients. Semin Dial 2008; 10:46-51. [DOI: 10.1111/j.1525-139x.1997.tb00459.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Namdari S, Park MJ, Weiss APC, Carney WI. Chronic hand ischemia treated with radial artery balloon angioplasty: case report. J Hand Surg Am 2008; 33:551-4. [PMID: 18406959 DOI: 10.1016/j.jhsa.2007.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 12/27/2007] [Accepted: 12/31/2007] [Indexed: 02/02/2023]
Abstract
Although balloon angioplasty in heart and lower extremity vessels has been extensively studied and reported, little information exists regarding its use for digital ischemia in the hand. We report a case of successful balloon angioplasty of the distal radial artery to reverse present and prevent further digital tip cyanosis and necrosis.
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Affiliation(s)
- Surena Namdari
- Division of Vascular Surgery and the Department of Orthopaedics, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
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Plumb TJ, Lynch TG, Adelson AB. Treatment of steal syndrome in a distal radiocephalic arteriovenous fistula using intravascular coil embolization. J Vasc Surg 2008; 47:457-9. [DOI: 10.1016/j.jvs.2007.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 07/27/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
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Asif A. ASDIN Focus: What Should Nephrologists Know About Hand Ischemia? Semin Dial 2007. [DOI: 10.1111/j.1525-139x.2007.00354.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thermann F, Ukkat J, Wollert U, Dralle H, Brauckhoff M. Dialysis shunt-associated steal syndrome (DASS) following brachial accesses: the value of fistula banding under blood flow control. Langenbecks Arch Surg 2007; 392:731-7. [PMID: 17602241 DOI: 10.1007/s00423-007-0207-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2006] [Accepted: 06/05/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dialysis shunt-associated steal syndrome (DASS) is a rare complication of hemodialysis access (HA) which preferably occurs in brachial fistulas. Treatment options are discussed controversially. Aim of this study was to evaluate flow-controlled fistula banding. MATERIALS AND METHODS Patients treated between 2002 and 2006 were included in this prospective survey. According to a classification we established, patients were typed DASS I-III (I: short history, no dermal lesions; II: long history, skin lesions; III: long history, gangrene). Surgical therapy was HA banding including controlled reduction (about 50% of initial flow) of HA blood flow (patients type I and II). Patients with type III underwent closure of the HA. RESULTS In 15 patients with relevant DASS, blood-flow-controlled banding was performed. In ten patients (all type I), banding led to restitution of the hand function while preserving the HA. In five patients (all type II), banding was not successful; in two patients, closure of the HA was performed eventually. In five patients (type III), primary closure of the HA was performed. Four patients with DASS type II but only two with DASS type I had diabetes mellitus (p = 0.006). CONCLUSIONS Banding under blood flow control resulting in an approximately 50% reduction in the initial blood flow is an adequate therapeutic option in patients with brachial HA and type I-DASS. In type II-DASS, banding does not lead to satisfying results, more complex surgical options might be more successful. Diabetes is associated with poor HA outcome in case of DASS.
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Affiliation(s)
- Florian Thermann
- Department of General, Visceral and Vascular Surgery, University Hospital Halle/Saale, Ernst-Grube-Strasse 40, 06097 Halle, Germany.
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Dineen S, Smith S, Arko FR. Successful Percutaneous Angioplasty and Stenting of The Radial Artery in a Patient with Chronic Upper Extremity Ischemia and Digital Gangrene. J Endovasc Ther 2007; 14:426-8. [PMID: 17723011 DOI: 10.1583/06-2017.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To report percutaneous treatment of a chronic radial artery occlusion in a multimorbid patient with ischemic tissue loss. CASE REPORT A 62-year-old man with multiple comorbidities, including renal failure and severe coronary artery disease, presented with painful, ulcerated lesions of his right hand. He has severe peripheral vascular disease, with a history of 4 digital amputations of the left hand, a right above-knee amputation, and a left femoral to peroneal artery bypass. Arteriography demonstrated chronic occlusion of the radial and ulnar arteries, with a patent interosseous and collateral flow to the distal radial artery filling the palmar arch. Angioplasty and stenting of the radial artery was performed, relieving the patient's symptoms and allowing the lesions to heal. CONCLUSION Percutaneous intervention can treat severe upper extremity ischemia with gangrene in patients with severe chronic ischemia and multiple comorbidities.
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Affiliation(s)
- Sean Dineen
- Department of Surgery, University of Texas Southwestern, Dallas, Texas 75390, USA
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