Hand ischemia in patients with hemodialysis access grafts: angiographic diagnosis and treatment.
OBJECTIVE
To determine the cause of symptoms and efficacy of transcatheter therapy in a series of patients with dialysis grafts and hand pain referred for arteriography.


METHODS
Thirteen patients with 14 hemodialysis grafts underwent arteriography for possible hand ischemia. The sites of proximal graft anastomosis were the distal radial artery (n = 6) and the mid- to distal brachial artery (n = 6). Transcatheter therapy was performed via the graft or by antegrade brachical puncture.


RESULTS
The cause of symptoms was ischemia from obstructive arterial disease in seven cases (three with superimposed steal), graft steal alone in three, ischemic monomelic neuropathy in two, and carpal tunnel syndrome in two. Five arterial stenoses were treated with angioplasty, with improvement or resolution of symptoms in four patients.


CONCLUSIONS
In this group, symptoms were usually the result of inflow or outflow arterial disease, alone or in combination with graft steal. Transcatheter therapy (angioplasty or embolization) is effective in selected cases.
Valji
K
K
Department of Radiology, University of California, San Diego Medical Center 92103-8756, USA.
Hye
R J
RJ
Roberts
A C
AC
Oglevie
S B
SB
Ziegler
T
T
Bookstein
J J
JJ
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000601:surgery; D002349:Carpal Tunnel Syndrome / Q000150:complications; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply* / Q000294:innervation; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000150:complications; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies