title: Chronic hemodialysis access-induced distal ischemia (HAIDI): distinctive form of a major complication.
abstract: OBJECTIVE
  Hemodialysis access-induced distal ischemia (HAIDI) is an uncommon but potentially devastating complication. HAIDI is classified as acute, subacute and chronic based upon the time of onset. The aim of this study was to determine the prevalence, severity, patients' characteristics and the underlying etiologic mechanism of chronic HAIDI using color Doppler ultrasonography (CDUS).
  
  
  METHODS
  Between June and August 2010, 676 hemodialysis patients with arteriovenous access (AVA) were evaluated for clinical evidence of chronic HAIDI. In the case-control part of the study, CDUS findings were compared between ischemic patients and asymptomatic matched controls. Also, patients with chronic HAIDI were followed up until February 2014, access ligation, kidney transplantation or death.
  
  
  RESULTS
  Eighteen chronic HAIDI patients were diagnosed (2.66%). Cold hand and cold sensation were the most common signs and symptoms of hand ischemia, respectively. Fifteen patients were classified in stage 1. Patients with proximal autogenous arteriovenous fistula, younger age, more previous AVAs and less access age were more likely to develop chronic HAIDI. Excessive fistula flow was found in the majority of ischemic patients (83.3%). The mean fistula flow was significantly higher in cases compared to controls (p=0.001). Eleven patients with chronic HAIDI were successfully treated by conservative measures alone until the end of follow-up (n=3), kidney transplantation (n=4) or death (n=4).
  
  
  CONCLUSIONS
  CDUS is a useful adjunctive diagnostic tool to determine the etiology of chronic HAIDI. Conservative measures combined with close follow-up can be used as the first step in the management of chronic HAIDI patients with mild symptoms.
authors.affiliation: Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad - Iran.
authors.forename: Mohammad-Hadi Saeed
authors.initials: MH
authors.lastname: Modaghegh
authors.forename: Gholamhossein
authors.initials: G
authors.lastname: Kazemzadeh
authors.forename: Masoud
authors.initials: M
authors.lastname: Pezeshki Rad
authors.forename: Hassan
authors.initials: H
authors.lastname: Ravari
authors.forename: Shahab
authors.initials: S
authors.lastname: Hafezi
authors.forename: Alaa
authors.initials: A
authors.lastname: El-Husheimi
authors.forename: Amir
authors.initials: A
authors.lastname: Barzanouni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001833:Body Temperature Regulation; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007492:Iran / Q000453:epidemiology; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013697:Thermosensing; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult