title: Relationship of hemodialysis access to finger gangrene in patients with end-stage renal disease.
abstract: OBJECTIVE
  We report a comprehensive review of our patients on hemodialysis with end-stage renal disease (ESRD) with finger gangrene to determine etiology, natural history, and prognosis of this condition.
  
  
  METHODS
  Patients with ESRD with finger gangrene were identified from our computerized vascular registry. Presence of an ipsilateral arteriovenous fistula was determined, and patients were compared with a group of patients with ESRD without finger gangrene. Management consisted of arteriography, selective arteriovenous fistula management, and finger amputation. A multivariate analysis to determine risk factors associated with finger gangrene was performed. Repeat finger amputation and survival rates were determined with life-table analysis.
  
  
  RESULTS
  Twenty-three patients (mean age at start of dialysis, 53 years) with finger gangrene were identified, with 48% (n = 11) having a functional ipsilateral arteriovenous fistula. Arteriography was consistent with diffuse atherosclerosis involving the radial, ulnar, palmar, and digital arteries precluding attempts at distal arterial bypass. Repeat finger amputations were necessitated in 52% of patients (n = 12), and bilateral finger gangrene developed in 61% of patients (n = 14). Starting dialysis at age less than 55 years (P =.0004), diabetes (P =.001), coronary artery disease (P =.0212), and lower extremity arterial occlusive disease (P <.0001) were significantly associated with finger gangrene.
  
  
  CONCLUSIONS
  The young diabetic patient with diffuse vascular disease and ESRD is at high risk for the development of finger gangrene on chronic hemodialysis. Finger gangrene is the result of distal atherosclerosis and is not primarily related to dialysis access.
authors.affiliation: Portland Veterans Affairs Medical Center and Oregon Health Sciences University, Portland, OR, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Yeager
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Moneta
authors.forename: James M
authors.initials: JM
authors.lastname: Edwards
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Landry
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Taylor
authors.forename: Donald B
authors.initials: DB
authors.lastname: McConnell
authors.forename: John M
authors.initials: JM
authors.lastname: Porter
mesh_terms: D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000150:complications; D001166:Arteriovenous Shunt, Surgical; D003925:Diabetic Angiopathies / Q000150:complications; D005260:Female; D005385:Fingers / Q000473:pathology*; D005734:Gangrene / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D012307:Risk Factors