title: Change in skin perfusion pressure after the creation of upper limb arteriovenous fistula for maintenance hemodialysis access.
abstract: Arteriovenous fistula (AVF) is the most important vascular access method for hemodialysis (HD). However, ischemic steal syndrome occasionally develops. This study evaluated the change in skin perfusion pressure (SPP) after the creation of upper limb AVF and analyzed the relationship between blood flow measurements and the change in SPP. The subjects included 21 patients who underwent radiocephalic AVF creation for the first time between November 2012 and September 2013. We measured SPP on the palm side of the third finger of both hands and assessed blood flow measurements using ultrasound examination before and after the creation of AVF. The subjects consisted of 15 men and 6 women (average age: 65.3 ± 12.7 years, including 12 diabetic patients). Observational period between before and after surgery was 4.9 ± 5.2 days. None of the patients had ischemic steal syndrome after the creation of AVF. Skin perfusion pressure tended to decrease after creation of AVF on the finger of AVF side (100.0 ± 20.9 vs. 87.9 ± 26.5 mmHg, P = 0.063). In contrast, SPP did not change in the limb without AVF (97.9 ± 20.7 vs. 101.0 ± 19.4 mmHg, P = 0.615). The rate of change in SPP was significantly decreased on the finger of AVF side compared with that of limb without AVF (0.055% vs. -0.112%, P = 0.014). There was no correlation between the change in SPP and blood flow measurements. Skin perfusion pressure is possible to detect ischemic steal syndrome after the creation of upper limb AVF.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
authors.forename: Shina
authors.initials: S
authors.lastname: Sueki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sakurada
authors.forename: Masahito
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Kayori
authors.initials: K
authors.lastname: Tsuruoka
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Matsui
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000368:Aged; D001132:Arm / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy; D008297:Male; D010477:Perfusion; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000379:methods*; D018570:Risk Assessment; D012867:Skin / Q000098:blood supply*
keywords: Skin perfusion pressure; arteriovenous fistula; steal syndrome