Time of onset in haemodialysis access-induced distal ischaemia (HAIDI) is related to the access type.
BACKGROUND
A small portion of haemodialysis patients develop hand ischaemia (HAIDI, haemodialysis access-induced distal ischaemia) in the presence of an arteriovenous access (AVA). It is unknown if the time of onset of ischaemia is related to the type of AVA. This review aims to investigate if a relationship is present between the type of AVA and the time of onset and intensity of HAIDI.


METHODS
Standard databases and reference lists of the pertinent literature were systematically searched. HAIDI was classified as 'acute' (<24 h after routine access construction), 'subacute' (within 1 month) or 'chronic' (>1 month). Location, type and follow-up of AVA were tabulated.


RESULTS
Twenty-one studies reporting on surgically or percutaneously corrected HAIDI patients (n = 464) fulfilled the inclusion criteria. Acute HAIDI strongly (88%) correlated with non-autogenous AVA. In contrast, chronic HAIDI was predominantly (91%) observed following autogenous AVA based on the cubital segment of the brachial artery. A simple clinical classification for chronic HAIDI guiding treatment strategies is proposed.


CONCLUSIONS
Hand ischaemia occurring early after routine access surgery is usually related to grafts and not to autogenous access construction. If patients have several risk factors for acute hand ischaemia (diabetes), nephrologists and vascular surgeons may choose an autogenous AVA. A disadvantage of an autogenous access is its association with chronic hand ischaemia, particularly if constructed with a brachial artery.
Scheltinga
Marc R
MR
Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. m.scheltinga@mmc.nl
van Hoek
Frank
F
Bruijninckx
Cornelis Maria Adrianus
CM
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D006435:Renal Dialysis; D013997:Time Factors