Banding of hemodialysis access to treat hand ischemia or cardiac overload.
A hemodialysis access may lead to cardiac overload (CO) or hand ischemia [hemodialysis access induced distal ischemia (HAIDI). Surgical banding restricts access flow and promotes distal perfusion. Aim of the study was to investigate short- and long-term clinical success of banding in these patient groups. After evaluation using a standard protocol, banding procedures (n = 19) were performed in patients (n = 17) with a hemodialysis access flow > or =2 l/minute or with refractory HAIDI. Various parameters including access flow, digital brachial index (DBI), and symptomatology of hand ischemia using a standard scoring system were determined before and after the operation. Surgical banding in CO patients (n = 9) lowered access flows by 2 l (Flow(preop) 3.2 +/- 0.3 l/minute vs. Flow(postop) 1.2 +/- 0.1 l/minute, p < 0.001). Banding in HAIDI patients (n = 10) increased DBI from 0.52 +/- 0.08 to 0.65 +/- 0.08 (p = 0.05), whereas ischemic symptomatology was attenuated (153 +/- 33 to 42 +/- 15, p < 0.02). All patients successfully continued dialysis, and immediate access occlusions (<3 months) were not observed. Access flows remained at acceptable levels after a mean follow-up of 30 months in surviving patients (n = 11, flow: 1.0 +/- 0.1 l/min). Two patients were reoperated for recurrent CO (one and 28 months postoperatively). Surgical banding monitored by measurement of flow and finger pressures is an effective short- and long-term treatment modality for hemodialysis access related CO or distal ischemia.
Department of Surgery, Máxima Medical Center, de Run 4600, Veldhoven, The Netherlands.
Frank
F
van Hoek
Marc
M
Scheltinga
Martin
M
Luirink
Huub
H
Pasmans
Charles
C
Beerenhout
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply*; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008026:Ligation; D010865:Pilot Projects; D010991:Plethysmography; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*; D016277:Ventricular Function, Left