Upper limb ischaemia after formation of dialysis fistula

• Authors: Krzysztof Bojakowski , Rafał Góra , Grzegorz Jodkowski , Piotr Andziak
• Languages of publication: EN

Abstracts

EN

Limb ischaemia caused by formation of dialysis fistula is rare but serious complication. The severity of symptoms may vary but rest pains and necrotic lesions are observed in most advance cases. In these patients different invasive procedures for treatment are performed - from simplest dialysis fistula ligation to complicated vascular reconstructions. The aim of the study was to evaluate treatment results of upper limb ischaemia triggered by dialysis fistula. Material and methods. We have analysed methods and results of treatment of 14 patients with symptomatic upper limb ischaemia caused by dialysis fistula treated in our department between 1st January, 2006 and 30th June, 2013. Treatment was subject to anatomical situation and clinical symptoms. In three patients the ligation of dialysis fistula was performed, four patients underwent inflow reconstruction - in one case by ligation of ligation of vein branch, in three patients by cephalic transfer of arterial anastomosis. In 2 patients hyperkinetic fistula aneurysm was excised and replaced by PTFE bypass, in three patients fistula reconstruction with DRIL method (distal revascularization - interval ligation) was performed, in one patient surgical operation of brachial artery stenosis was conducted. One patient underwent brachial artery angioplasty. Results. Rest pains occurred in all patients (100%), regressive changes in 10 patients (71.4%). Eight patients (57.2%) had concomitant diabetes, seven (50%) ischaemic heart disease, five (35.5%) chronic lower limb ischemia and hyperparathyroidism was observed in fivepatients (35.5%). The imaging studies in all patients revealed pathological steal syndrome (stealing blood to the fistula), in majority concurrent with other pathologies - obstruction stenosis of peripheral artery, defects in blood out flow from the limb. As a result of the surgical treatment, symptoms of limb ischaemia subsided in all patients. Conclusions. Critical limb ischaemia caused by dialysis fistula is a dangerous complication. In most cases there are several causes of ischaemia. Treatment methods should be selected individually for each patient and clinical situation. Clinical symptoms should subside as a result of optimal choice of treatment and, if possible, maintaining of dialysis access.

Keywords

EN

hand ischemia; dialysis fistula; vascular access complications

• Journal: Polish Journal of Surgery
• Year: 2013
• Volume: 85
• Issue: 11
• Pages: 649-656

Dates

published

1 - 11 - 2013

online

31 - 12 - 2013

Contributors

author

Krzysztof Bojakowski

• Department of General and Cardiovascular Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw

author

Rafał Góra

• Department of General and Cardiovascular Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw

author

Grzegorz Jodkowski

• Department of General and Cardiovascular Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw

author

Piotr Andziak

• Department of General and Cardiovascular Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw

References

• 1. Leon C, Asif A: Arteriovenous Access and Hand Pain: The Distal Hypoperfusion Ischemic Syndrome. Clin J Am Soc Nephrol 2007; 2: 175-83.[PubMed][WoS]
• 2. Keuter A, Kessels AGH , de Haan et al.: Prospective Evaluation of Ischemia in BrachialeBasilic and Forearm Prosthetic Arteriovenous Fistulas for Hemodialysis. Eur J Vasc Endovasc Surg 2008; 35, 619-24.[PubMed][WoS][Crossref]
• 3. Sunding PN, Wilson SE : Strategies for management of ischemic steal syndrome. Semin Vasc Surg 2007; 20:184-88.[WoS][Crossref]
• 4. Tynan-Cuisinier GS , Berman SS : Strategies for Predicting and Treating Access Induced Ischemic Steal Syndrome. Eur J Vasc Endovasc Surg 2006; 32: 309-15.[Crossref]
• 5. Yu SH , Cook PR, Canty TG et al.: Hemodialysis- Related Steal Syndrome: Predictive Factors and Response to Treatment with the Distal Revascularization- Interval Ligation Procedure. Ann Vasc Surg 2008; 22: 210-14.[WoS][PubMed][Crossref]
• 6. Scali ST , Huber T: Treatment Strategies for Access-Related Hand Ischemia. Semin Vasc Surg 2011; 24: 128-36.[PubMed][Crossref]
• 7. Schanzer H, Schwartz M, Harrington E et al.: Treatment of ischemia due to “steal” by arteriovenous fistula with distal artery ligation and revascularization.[PubMed]
• J Vasc Surg 1988; 7: 770-73.[PubMed]
• 8. Aimag R, Katz SG : Using distal revascularization with interval ligation as the primary treatment of hand ischemia afterdialysis access creation. J Vasc Surg 2013 (w druku).[WoS]
• 9. Knox RC , Berman SS , Hughes JD et al.: Distal revascularization-interval ligation: A durable and effective treatment for ischemic steal syndrome after hemodialysis access. J Vasc Surg 2002; 36: 250-56.[PubMed][Crossref]
• 10. Walz P, Ladowski JS , Hines A: Distal Revascularization and Interval Ligation (DRIL) Procedure for the Treatment of Ischemic Steal Syndrome after Arm Arteriovenous Fistula. Ann Vasc Surg 2007; 21: 468-73.[PubMed][WoS][Crossref]
• 11. Zanow J, Kruger I, Scholz H: Proximalization of the arterial inflow: A new technique to treat access-related ischemia. J Vasc Surg 2006; 43: 1216-21.[PubMed][Crossref]
• 12. Thermann F, Wollert U: Proximalization of the Arterial Inflow: New Treatment of Choice in Patients with Advanced Dialysis Shunt-Associated Steal Syndrome? Ann Vasc Surg 2009; 23: 485-90.[Crossref][PubMed]
• 13. Vaes RH , Scheltinga MR: Side branch ligation for haemodialysis-access-induced distal ischaemia. Eur J Vasc Endovasc Surg 2012; 44: 452-56.[WoS][PubMed][Crossref]
• 14. Samaha A, Salman L, Asif A: Arterial angioplasty to treat hand ischemia in a radial-cephalic fistula. Semin Dial 2009; 22: 561-63.[WoS][Crossref]
• 15. Van Hoek F, Scheltinga M, Luirink M et al.: Banding of Hemodialysis Access to Treat Hand Ischemia or Cardiac Overload. Semin Dial 2009; 22: 204-08.[WoS][Crossref][PubMed]
• 16. Schneider CG , Gawad K, Strate T et al.: Tbanding: A technique for flow reduction of a hyperfunctioning arteriovenous fistula. J Vasc Surg 2006; 43: 402-05.[Crossref][PubMed]
• 17. Yaghoubian A, de Virgilio C: Plication as Primary Treatment of Steal Syndrome in Arteriovenous Fistulas. Ann Vasc Surg 2009; 23: 103-07.[Crossref]
• 18. Chemla ES , Morsy M,Anderson Liz et al.: Inflow Reduction by Distalization of Anastomosis Treats Efficiently High-Inflow High-Cardiac Output Vascular Access for Hemodialysis. Seminars in Dialysis 2007; 20: 68-72.[WoS][Crossref][PubMed]
• 19. Minion DJ , Moore E, Endean E: Revision Using Distal Inflow: A Novel Approach to Dialysis-associated Steal Syndrome. Ann Vasc Surg 2005; 19: 625-28. [PubMed][Crossref]

Identifiers

DOI

10.2478/pjs-2013-0098