Retarded hand growth due to a hemodialysis fistula in a young girl

Abstract

Long-term presence of an arteriovenous hemodialysis fistula (AVF) may lead to alterations in hand perfusion. In the case reported here, a 14-year-old girl developed pain associated with hand ischemia 5 years after a successful kidney transplantation. At age 8 years, she required a period of hemodialysis using an autogenous left upper arm AVF. Compared to the healthy right hand, a smaller ischemic left hand was observed in the presence of a patent AVF. Access flow was 1400 ml/min. Seldinger angiography demonstrated a stenotic brachial artery, and duplex measurements indicated a reversed blood flow in the radial artery. AVF ligation abolished the ischemic symptoms. Distal hypotension due to an impaired arterial inflow combined with a low resistance elbow AVF may result in chronic hypoperfusion of acral portions of the extremity and growth retardation. Access ligation is advised in children with an optimal renal transplant function and a patent elbow AVF suffering from lowered distal tissue perfusion.

The Osteoporotic Effect of Arteriovenous Fistula on the Ipsilateral Upper Extremity in Hemodialysis Patients

“…A study of 434 accesses in children found hemodialysis access-induced distal ischemia in 9%, but high access flow in only 1% (9). Frank van Hoek et al (13) reported a girl with a small ischemic left hand in the ipsilateralto-AVF hand with a patent AVF, whereas the contralateral-to-AVF hand was normal. They surmised that the abnormal AVF forearm was due to chronic tissue hypoxia and speculated that the AVF resulted in decreased nutrients being supplied to the distal tissues.…”