Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#25 MANAGEMENT OF HAND ISCHEMIA IN PATIENTS WITH HEMODIALYSIS ACCESS BY DISTAL ARTERIAL LIGATION AND REVASCULARIZATION
Peter H. Lin, MD, Changyi Chen, MD, PhD, Scott M. Suroweic, MD, Julie M. MacDonald, RN, Thomas F. Dodson, MD,
and Alan B. Lumsden, MB, ChB
Emory University School of Medicine Atlanta, GA
Purpose: Hand ischemia due to arterial steal syndrome is an infrequent but potentially serious complication of hemodialysis access procedures. Correction of symptomatic steal syndrome typically involves fistula ligation, arterial banding, or graft lengthening, which provide varying degrees of success. The purpose of this study is to evaluate our experience in the treatment of dialysis-associated hand ischenmia by distal artery ligation and revascularization.
Methods: A retrospective review was performed on fourteen patients over a six year period who developed hand ischemia following hemodialysis access construction and underwent distal artery ligation and revascularization. Patient demographic data, operative indications, intraoperative arteriograms, risk factors, and treatment outcome were noted.
Results: There were ten males and four females, with a mean age of 52 (range 21 to 73). Hand ischemia occurred in nine patients with arteriovenous fistulas and five patients with arteriovenous grafts. Nine patients developed steal syndrome within one month following the hemodialysis access procedure. All 14 patients underwent a surgical procedure for hand ischemia which included ligation of the artery distal to arteriovenous fistula and arterial bypass, with reverse saphenous vein grafts in 13 patients and polytetrafluoroethylene graft in one patient. One patient with severe digital gangrene also required amputation. There were no perioperative morbidity or mortality. Following operation, all showed immediate improvement of the affected hand and remained free of symptoms. The patency of the hemodialysis access following the corrective procedure was 85.7% at one year and 57.1% at two years. All arterial bypass remained patent during follow-up which ranged from one month to five years (mean 35 months).
Conclusions: Distal arterial ligation with revascularization is an effective and durable treatment for patients with arterial steal syndrome following hemodialysis access construction. This technique can be performed with minimal morbidity and maintains a continuous access for hemodialysis.
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Last updated January 10, 1999