Time of onset in haemodialysis access-induced distal ischaemia (HAIDI) is related to the access type

Scheltinga, Marc R.; Hoek, F. van; Bruijninckx, C.M.A.

doi:10.1093/ndt/gfp200

Cited by 67 publications

(90 citation statements)

References 39 publications

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“…Women, in the our research, have no higher risk for developing distal hypoperfusion, probably because they accounted for only one-third of our respondents. On the other hand, patients who had symptoms of distal ischemia were significantly older than those without this syndrome, which confirms old age as a factor that characterizes patients with DHIS [6,11] . Half of our respondents were smokers and this habit has been established as a significant feature in patients with pronounced symptoms of distal ischemia.…”

Section: Factors That Define Digital Hypoperfusion Ischemic Syndromementioning

confidence: 81%

“…A prerequisite for the occurrence of hand ischemia is reduced blood flow through the arterial system, excessive blood flow through distended blood vessels, inadequate vascular adaptation and reduced collateral perfusion. It is assumed that the incidence of ischemia could rise in the future due to popularization of vascular access in the proximal region of the elbow and the growing number of elderly people on dialysis [6,7] . The goal of this study was to determine clinical characteristics and survival parameters in patients with DHIS.…”

Section: Introductionmentioning

confidence: 99%

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Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Stolić¹

2013

WJN

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AIM:To determine survival parameters as well as characteristics of patients with this syndrome. METHODS:The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died. RESULTS:Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). KaplanMeier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e. , patients with confirmed digital hypoperfusion ischemic syndrome died earlier. CONCLUSION:Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.© 2013 Baishideng. All rights reserved.Key words: Digital hypoperfusion ischemic syndrome; Predictive parameters; Survival; Arteriovenous fistula; Hemodialysis Core tip: In order to prevent the occurrence of distal hypoperfusion syndrome, is important identification of risk factors. Problem is the absence of objective indicators of distal ischemia, which is main reason why large proportion our patients have of this symptoms. Our patients with these symptoms were significantly older, which confirms older age as a factor that characterizes BRIEF ARTICLE 26May 6, 2013|Volume 2|Issue 2| WJN|www.wjgnet.com patients with distal hypoperfusion syndrome. We have confirmed greater incidence of diabetes mellitus and smokers among the patients with distal hypoperfusion syndrome. Quality of dialysis, diabetes mellitus, erythropoietin therapy, smokers and hemodiafiltration has predictive value for survival of patients with distal ischemia.Stolic RV, Trajkovic GZ, Miric DJ, Kisic B, Djordjevic Z, Azanjac GL, Stanojevic MS, Stolic DZ. Arteriovenous fistulas and digital hypoperfusion ischemic ...

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Section: Factors That Define Digital Hypoperfusion Ischemic Syndromementioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Stolić¹

2013

WJN

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“…Some of its causes have been recognized in literature. Utilizing synthetic grafts;[2] old age patients, especially those with large bores graft access;[34] autogenous upper arm brachial-based AVFs in late chronic phase;[45] diabetes ground;[23] reduction in forearm arterial blood and bed pressure by high outflow exhaust through the graft or physically, turbulent flow at the arteriovenous anastomosis site;[678] side venous branches in AVFs;[8] severe peripheral arterial disease;[589] preoperative high digital-brachial index (DBI <0.45–1.0),[5610] and iatrogenic occurrence [11] are all previously known contributing factors for Steal development. The incidence of symptomatic Steal with hand ischemia ranges from 0.5% up to 28%.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic hemodialysis access-induced distal hand ischemia and its contributors in diabetics

et al. 2017

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Avoidance of hand ischemia in the construction of prosthetic access for hemodialysis in diabetics that have no suitable vein for arteriovenous fistula is appreciated. Taper type may be an appropriately matched conduit to prevent its occurrence. This is a prospective controlled trial of 38 selected diabetics requiring hemodialysis, who were referred to our clinic during a period of 6 months. The aim of the study was to evaluate the efficacy of tapered grafts in preventing distal hand hypoperfusion and determining its most likely contributors. In 18 intervening cases, taper 4 mm × 7 mm and in twenty cases (control group), standard 6 mm polytetrafluoroethylene as straight Brachial-Axillary access was used. Graft flow rates, artery and vein diameters, and mean arterial pressure were included for evaluation. Within the control group, 11 patients (55%) (7 cases Grade 1, 3 Grade 2, 1 Grade 3) and in intervening group, 2 cases (11%) (Grade 1, Grade 3) developed Steal syndrome. There was no significant difference in the mean flow rates (P = 0.82). Increased risk of distal hypoperfusion was observed in the control group when flow rates were more than 1000 ml/min. Arterial diameters (P = 0.011) and mean arterial pressure (P = 0.05) were found to be important contributing factors. Taper grafts causes reduced incidence of distal hand hypoperfusion. When artery diameter was <6 mm and mean arterial pressure lower than 100 mmHg and the index (brachial artery diameter × mean arterial pressure) was under 500, distal hand ischemia occurred in standard and tapper type. We therefore recommend selective usage of taper grafts in diabetics with diminished distal hand pulses, considering the contributing factors when fistula first is not feasible.

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“…ARHI tends to occur earlier relative to the index access for patients receiving an AVG. Scheltinga et al 25 reported from their systematic review that ARHI associated with AVGs tend to be acute, both in timing (< 24 hrs) and symptoms (i.e. acute ischemia), while that associated with AVFs tended to be more chronic (i.e.…”

Section: Discussionmentioning

confidence: 99%

Access-related hand ischemia and the Hemodialysis Fistula Maturation Study

Huber

Larive

Imrey

et al. 2016

Journal of Vascular Surgery

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Objectives Access-related hand ischemia (ARHI) is a major complication after hemodialysis access construction. This study was designed to prospectively describe its incidence, predictors, interventions and associated access maturation. Methods The Hemodialysis Fistula Maturation Study is a multicenter prospective cohort study designed to identify predictors of autogenous arteriovenous access (AVF) maturation. Symptoms and interventions for ARHI were documented and participants who received interventions for ARHI were compared to other participants using a nested case-control design. Associations of ARHI with clinical, ultrasound, vascular function, and vein histological variables were each individually evaluated using conditional logistic regression and the association with maturation assessed by relative risk, Pearson's chi-square test, and multiple logistic regression. Results The study cohort included 602 participants with median follow-up 2.1 years (10th - 90th percentiles: 0.7 - 3.5 yrs). Mean age was 55.1 ± 13.4 (SD) years and the majority were male (70%), Caucasian (47%), diabetic (59%), smokers (55%), on dialysis (64%), and underwent an upper arm AVF (76%). Symptoms of ARHI occurred in 45 (7%) participants and intervention was required in 26 (4%). Interventions included distal revascularization with interval ligation (13), ligation (7), banding (4), revision using distal inflow (1), and proximalization of arterial inflow (1). Interventions were performed ≤ 7 days after AVF creation in 4 participants (15%), between 8 - 30 days in 6 (23%) and > 30 days in 16 (63%). Female gender (OR 3.17: 95% CI 1.27 - 7.91, p = 0.013), diabetes (13.62: 1.81 - 102.4, p = 0.011), coronary artery disease (2.60: 1.03 - 6.58, p = 0.044), higher pre-operative venous capacitance (per % /10mmHg: 2.76: 1.07 - 6.52, p = 0.021) and maximum venous outflow slope (per (mL/100 mL/min) /10 mmHg: 1.13: 1.03 - 1.25, p = 0.011) were significantly associated with interventions, while a lower carotid-femoral pulse-wave velocity and the outflow vein diameter in the early postoperative period (days 0 - 3) approached significance (p < .10). Intervention for ARHI was not associated with AVF maturation failure (unadjusted risk ratio 1.18: 0.69 - 2.04, p = 0.56, adjusted odds ratio 0.97: 0.41 - 2.31, p = 0.95). Conclusions Remedial intervention for ARHI after AVF construction is uncommon. Diabetes, female gender, capacitant outflow veins and coronary artery disease are all associated with an increased risk of intervention. These higher risk patients should be counseled preoperatively, their operative plans designed to reduce the risk of hand ischemia, and followed closely.

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Time of onset in haemodialysis access-induced distal ischaemia (HAIDI) is related to the access type

Cited by 67 publications

References 39 publications

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Prosthetic hemodialysis access-induced distal hand ischemia and its contributors in diabetics

Access-related hand ischemia and the Hemodialysis Fistula Maturation Study

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