Skin perfusion pressure for predicting access-related hand ischemia following arteriovenous fistula surgery based on the brachial artery

Abstract

Background: Access-related hand ischemia (ARHI) is a major complication of arteriovenous fistula (AVF). This study aimed to assess the predictive efficacy of skin perfusion pressure (SPP) measurement for ARHI by examining the relationship between SPP and ARHI development and progression after AVF surgery. Methods: Twenty-five patients (16 men and 9 women) who underwent AVF surgery based on the brachial artery between January 2018 and December 2018 were included. The pre- and postoperative SPP values were measured on the day of surgery. ARHI occurrence and severity were measured within 3 days and at 6 months after surgery. Receiver operating characteristic curve analysis was used to evaluate the prediction model of ARHI, and the cutoff points for the calculated coefficients were determined. Results: There was a significant correlation between the occurrence of immediate ARHI and the SPP gradient ( p = 0.024). An SPP gradient value >50 mmHg had sensitivity and specificity values of 53.85% and 91.67%, respectively, in predicting the occurrence of immediate ARHI. A postoperative SPP <48 mmHg was significantly correlated with the occurrence of 6-month ARHI ( p = 0.005), with sensitivity and specificity values of 71.43% and 83.33%, respectively. Conclusion: The SPP gradient and postoperative SPP values may be effective clinical predictors of ARHI occurring immediately and 6 months after surgery, respectively, with high specificity. These findings could allow clinicians to diagnose and begin early interventions to help prevent ischemic tissue damage in hemodialysis patients following AVF surgery.

The correlation between transcutaneous oxygen pressure (TcPO2) and forward‐looking infrared (FLIR) thermography in the evaluation of lower extremity perfusion according to angiosome

“…Unlike ABI and TBI, arterial calcification does not affect SPP; thus, enabling a relatively accurate arterial function assessment. 25 Colour Doppler ultrasonography is non-invasive, reproducible and cost-effective, making it the preferred choice in clinical practice. However, it has limitations regarding panoramic view, potential subjectivity and physical constraints owing to the use of ultrasound.…”

“…SPP measures the microcirculation in the skin using laser Doppler. Unlike ABI and TBI, arterial calcification does not affect SPP; thus, enabling a relatively accurate arterial function assessment 25 …”

“…Unlike ABI and TBI, arterial calcification does not affect SPP; thus, enabling a relatively accurate arterial function assessment. 25 …”