Particularity of Hemodynamics in Hemodialysis Patients With Hand Ischemia

Abstract

Introduction. Successful hemodialysis is impossible without effective vascular access. However, the average duration of its normal functioning is 2.53.0 years that is associated with complications, one of them is steal syndrome of the hand. Objective. To examine hemodynamic parameters in vascular access and forearm arteries in hemodialysis patients with hand ischemia. Methods. Duplex ultrasound was performed in 550 patients, 517 of which (94.0%) had an arteriovenous fistula, 33 (6.0%) had an arteriovenous graft. The inflow artery, anastomotic zone, outflow vein and arteries distal to the anastomotic zone were assessed during ultrasound examination, linear and volumetric speed indicators, peripheral resistance indices were measured. Results. Steal syndrome was detected in 2.7% of cases. The main reasons are the inflow artery alterations due to diabetes and atherosclerosis that lead to insufficient growth of blood flow through the artery (20,0%); huge anastomosis diameter that causes a vein dilation and significant increase in access flow (13,3%); insufficient blood flow through the ulnar, anterior interosseous arteries and the absence of collateral branches that did not compensate for retrograde blood flow in the radial artery distal to anastomosis (40,0%); microcirculatory dysfunction of the hand and alterations of the regulation mechanisms of the resistive vessels tone (26,7%). Conclusion. Dynamic ultrasound examination of vascular access can detect adverse changes in hemodynamics and avoid severe ischemic complications. The main reason of steal syndrome is the condition of the forearm arteries not participating in the fistula formation and the hand microvasculature.