title: Vascular access-induced hand ischemia: risks and safe management.
abstract: Hand ischemia is rare but complex and multifactorial. Distal arteriopathy below the vascular access (VA) is responsible in the vast majority of patients and not a problem of high flow of the VA. Therefore, surgical technique should focus on improving blood flow and pressure instead of reducing blood flow. We present an overview of the standard techniques which are recommended to treat VA-induced hand ischemia. The banding techniques, most of which empirical and not codified, have been abandoned by the majority of the authors because of a high rate of failure and reintervention. Ligation may be necessary in patients with severe ischemia and diffuse arterial lesions and in case of ischemic monomelic neuropathy.
authors: Departments of Vascular and Thoracic Surgery, University Hospital Grenoble, Grenoble, France.
authors: Carmine
authors: C
authors: Sessa
authors: Albéric
authors: A
authors: De Lambert
authors: Augustin
authors: A
authors: Pirvu
authors: Pedro
authors: P
authors: Palacin
authors: Olivier
authors: O
authors: Pichot
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019468:Disease Management; D006225:Hand / Q000098:blood supply*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007511:Ischemia / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D008026:Ligation; D061214:Patient Safety; D017534:Radial Artery / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012307:Risk Factors; D017535:Ulnar Artery / Q000502:physiology; D062666:Vascular Access Devices / Q000009:adverse effects*; D014656:Vascular Surgical Procedures / Q000379:methods