[Hand ischemia due to "steal syndrome" in vascular access for hemodialysis].
Among complications of vascular access operations, symptomatic steal syndrome is uncommon, but may lead to ischemia of the hand. Between 1983 and 1995, 5 patients with hemodialysis fistulas presented rest pain of finger necrosis with a wrist-brachial index of 0.56 (range 0.35 to 0.63) improving to 0.96 (range 0.72 to 1.05) after digital pressure of the fistula. Ligation of distal radial artery was performed in 3 patients with side-to-end radiocephalic fistula, while basilic vein was distally ligated in a case of side-to-side brachiobasilic fistula. A vein "banding" procedure reduce fistula flow and improved distal perfusion in one patient, while a true venous aneurysm of the cephalic vein was treated by excision and replacement with a tapered PTFE graft. Hemodynamic assessment is required during surgical correction, but it may also be useful in pre- and intra-operative evaluation of patients undergoing therapeutical AVFs to prevent arterial insufficiency of the hand.
Porcellini
M
M
Cattedra di Chirurgia Vascolare, Università degli Studi di Napoli Federico II.
Selvetella
L
L
De Rosa
P
P
Baldassarre
M
M
Bauleo
A
A
Capasso
R
R
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001807:Blood Vessel Prosthesis; D005260:Female; D006225:Hand / Q000098:blood supply*; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis
D011138:Polytetrafluoroethylene