title: Operative management of distal ischemia complicating upper extremity dialysis access.
abstract: BACKGROUND
  Ischemia distal to a functioning arteriovenous dialysis access is an infrequent but potentially serious complication that can be difficult to manage while maintaining access patency.
  
  
  METHODS
  Retrospective review was made of all patients requiring operative intervention for dialysis access-induced distal ischemia from 1998 to 2002 in a tertiary vascular surgery referral practice.
  
  
  RESULTS
  Twelve patients had 13 hands with ischemic changes requiring intervention after placement of hemodialysis access. Ischemia was successfully treated in all cases by distal revascularization-interval ligation. Dialysis access patency was better than expected.
  
  
  CONCLUSIONS
  Distal revascularization-interval ligation is the optimal management for dialysis access-induced ischemia and should be attempted whenever possible.
authors.affiliation: Vascular Institute of the Northwest, 1600 E Jefferson, No. 101, Seattle, WA 98122, USA.
authors.forename: Lance
authors.initials: L
authors.lastname: Diehl
authors.forename: Kaj
authors.initials: K
authors.lastname: Johansen
authors.forename: Jim
authors.initials: J
authors.lastname: Watson
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome