The hemodialysis patient and hand amputation

Area of Science:

• Vascular Surgery
• Nephrology
• Patient Safety

Background:

• Hemodialysis access surgery is crucial for patients with end-stage renal disease.
• Access procedures can cause physiological steal, potentially leading to hand ischemia.
• Risk factors like peripheral vascular disease, diabetes, and synthetic grafts increase complication incidence.

Observation:

• This article details three cases of patients requiring hand amputation due to severe ischemia post-hemodialysis access.
• Clinical features of these severe cases are presented.
• The incidence of digital or hand ischemia is significantly increased in patients with specific risk factors.

Findings:

• Severe hand ischemia necessitating amputation is a rare but significant complication of hemodialysis access.
• Multiple pre-existing conditions and the use of synthetic grafts are associated with increased risk.
• Review of literature identifies key factors promoting this complication.

Implications:

• Highlights the critical need for careful patient selection and monitoring after hemodialysis access surgery.
• Suggests that all-autogenous vascular access policies may be a strategy to prevent hand ischemia.
• Emphasizes the importance of considering patient comorbidities when planning vascular access procedures.