A comparison of revision using distal inflow and distal revascularization-interval ligation for the management of severe access-related hand ischemia

Misskey, Jonathan; Yang, Cathevine; MacDonald, Shaun; Baxter, Keith; Hsiang, York

doi:10.1016/j.jvs.2015.10.100

Cited by 28 publications

(22 citation statements)

References 29 publications

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“…Different surgical and endovascular techniques to resolve HAIDI symptoms have been described. 1,29–31 However, in our series one patient suffered from severe symptoms and therefore surgical access ligation was necessary for upper limb salvage. The decision for access abandonment and against other possible surgical procedures as distal reconstruction, interval ligation, or inflow improvement was based on the severity of symptoms in this multimorbid female patient.…”

Section: Discussionmentioning

confidence: 71%

Pilot study using intraoperative fluorescence angiography during arteriovenous hemodialysis access surgery

Regus

Lang

et al. 2018

J Vasc Access

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Section: Discussionmentioning

confidence: 71%

Pilot study using intraoperative fluorescence angiography during arteriovenous hemodialysis access surgery

Regus

Lang

et al. 2018

J Vasc Access

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“…For instance, one study demonstrated 78% 3 year patency rates in patients with hand ischaemia. 30 A second study found 87% 1 year secondary patency rates in 29 patients with hand ischaemia or HFA. 13 A third study using PTFE interposition grafts reported 77% secondary patency rates after 16 months.…”

Section: Discussionmentioning

confidence: 97%

Three Year Patency and Recurrence Rates of Revision Using Distal Inflow with a Venous Interposition Graft for High Flow Brachial Artery Based Arteriovenous Fistula

Gerrickens

Vaes

Govaert

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…[8][9][10] Three-and four-year survival rates were approximately 50% and 42% in two other samples having hand ischemia. 23,24 Survival rates of HD patients with or without HAIDI were never compared in a single dialysis facility. The present single center study hypothesized that patients with severe HAIDI (Grade IIb-IV) had lower survival compared with HD patients with mild (Grade I-IIa), or no HAIDI.…”

Section: Discussionmentioning

confidence: 99%

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

et al. 2020

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Background: Some hemodialysis patients develop hemodialysis access-induced distal ischemia due to insufficient loco-regional perfusion pressure and consequent poor arterial flow. We hypothesized that patients with severe hemodialysis access-induced distal ischemia had worse survival compared with patients with mild or no hemodialysis access-induced distal ischemia. Methods: This single-center retrospective observational cohort study included three groups of prevalent hemodialysis patients with an upper extremity vascular access between 2006 and 2018. Symptomatic patients had signs and symptoms of hemodialysis access-induced distal ischemia and low digital brachial indices (<60%) and were divided into a mild (Grade I–IIa) and a severe hemodialysis access-induced distal ischemia (IIb–IV) group. The control group consisted of hemodialysis patients without signs of hemodialysis access-induced distal ischemia with digital brachial indices ≥60%. Factors potentially related to 4-year survival were analyzed. Results: Mild hemodialysis access-induced distal ischemia-patients displayed higher digital brachial indices ( n = 23, 41%, ±3) compared with severe hemodialysis access-induced distal ischemia-patients ( n = 28, 24%, ±4), whereas controls had the highest values ( n = 48, 80%, ±2; p < .001). A total of 44 patients (44%) died during follow-up. Digital brachial index (hazards ratio 0.989 [0.979–1.000] p = .046) was related to overall mortality following correction for presence of arterial occlusive disease (hazards ratio 2.28 [1.22–4.29], diabetes (hazards ratio 2.00 [1.07–3.72], and increasing age (hazards ratio 1.03 [1.01–1.06] as was digital pressure (hazards ratio 0.990 [0.983–0.998], p = .011). Overall survival was similar in mild hemodialysis access-induced distal ischemia and controls (2-year, 79% ±5; 4-year, 57% ±6, p = .818). In contrast, 4-year survival was >20% lower in patients with severe hemodialysis access-induced distal ischemia (2-year 62%± 10; 4-year 34% ± 10; p = .026). Conclusion: Presence of severe hemodialysis access-induced distal ischemia may be associated with poorer survival in hemodialysis patients. Lower digital brachial index values are associated with higher overall mortality, even following correction for other known risk factors.

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A comparison of revision using distal inflow and distal revascularization-interval ligation for the management of severe access-related hand ischemia

Cited by 28 publications

References 29 publications

Pilot study using intraoperative fluorescence angiography during arteriovenous hemodialysis access surgery

Pilot study using intraoperative fluorescence angiography during arteriovenous hemodialysis access surgery

Three Year Patency and Recurrence Rates of Revision Using Distal Inflow with a Venous Interposition Graft for High Flow Brachial Artery Based Arteriovenous Fistula

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

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