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Operative management of distal ischemia complicating upper extremity dialysis access
Lance Diehl1, Kaj Johansen, Jim Watson
1Vascular Institute of the Northwest, 1600 E Jefferson, No. 101, Seattle, WA 98122, USA.
Background:
Ischemia distal to a functioning arteriovenous dialysis access is an infrequent but potentially serious complication that can be difficult to manage while maintaining access patency.
Methods:
Retrospective review was made of all patients requiring operative intervention for dialysis access-induced distal ischemia from 1998 to 2002 in a tertiary vascular surgery referral practice.
Results:
Twelve patients had 13 hands with ischemic changes requiring intervention after placement of hemodialysis access. Ischemia was successfully treated in all cases by distal revascularization-interval ligation. Dialysis access patency was better than expected.
Conclusions:
Distal revascularization-interval ligation is the optimal management for dialysis access-induced ischemia and should be attempted whenever possible.