Portal de Periódicos da CAPES

Upper Extremity Ischemia and Hemodialysis Vascular Access

2003; Elsevier BV; Volume: 27; Issue: 1 Linguagem: Inglês

10.1016/j.ejvs.2003.10.007

1532-2165

Jan H.M. Tordoir, Rúben Dammers, Frank M. van der Sande,

Vascular anomalies and interventions

Abstract Digital ischemia in dialysis patients due to arteriovenous fistulas (AVF) is a rare condition, occurring in 4% of patients. The etiology is different from lower limb ischemia. Blood shunting through the AVF may cause stealing of blood and hypoperfusion in distal tissues, leading to pain, discolorisation and ulcers. High-flow AVFs have greater risk on ischemia than normal flow AVFs, however combined with peripheral arteriosclerotic disease the latter may also leads to ischemia. A non-invasive and angiographic diagnosis is of importance to determine treatment options. Augmentation of arterial inflow by interventional techniques and/or AVF bloodflow-reducing surgical procedures may eliminate pain and heal ulcers. The best results are obtained by bypassing the arteriovenous anastomotic site and interruption of steal phenomenon by ligation of the artery distal to the AV anastomosis.