Abstract
Distal hypoperfusion ischemic syndrome (DHIS) is a serious complication that can lead to amputation of the digits or entire hand. Any complaint of hand pain ipsilateral to a dialysis access should be considered as due to DHIS until proven otherwise. Three underlining mechanisms act either in isolation or in concert: presence of arterial lesions, steal effect of the vascular access, and chronic venous hypertension. Duplex ultrasonography must involve a detailed study of the entire upper extremity arterial architecture, with mandatory access flow measurement. Arteriography must include imaging of the entire upper extremity arterial circulation from the ostium of the subclavian artery to the digits. Access ligation and other surgical options are considered only after a central arterial stenosis amenable to percutaneous dilation has been ruled out. The aims of surgical treatment are to reduce access flow and hence steal and/or improve distal perfusion. Surgical options include banding, revision using distal inflow, distal revascularization interval ligation, proximalization of arterial inflow for upper arm accesses and banding, distal radial artery ligation, or embolization for forearm accesses.
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Turmel-Rodrigues, L., Renaud, C.J. (2013). Hand Ischemia. In: Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis. Springer, Paris. https://doi.org/10.1007/978-2-8178-0366-1_11
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DOI: https://doi.org/10.1007/978-2-8178-0366-1_11
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