ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists

Abstract

IntroductionHemodialysis access-induced distal ischemia (HAIDI) has been reported to have an incidence of 1%-8%. 1 However, this is based on referred cases requiring surgical treatment. Its true frequency is dependent upon the symptom threshold used to qualify for the diagnosis. Systematic patient evaluation has shown that mild to moderate symptoms occur much more frequently. 2 The reported incidence relates to the upper extremity and is the topic of this review. Access-related distal ischemia can also involve the lower extremity with serious consequences. 3,4 An understanding of HAIDI and the appropriate role of the interventional nephrologist in its management is important when patients present with symptoms suggestive of HAIDI. Herein, the pathophysiology of the syndrome is discussed followed by recommendations for its diagnosis and management and the basis for the recommendations. These recommendations ASDIN white paper: Assessment and management of hemodialysis accessinduced distal ischemia by interventional nephrologists AbstractAlthough not common, hemodialysis access-induced distal ischemia is a serious condition resulting in significant hemodialysis patient morbidity. Patients with signs and symptoms suggestive of hand ischemia frequently present to the general and interventional nephrologist for evaluation. In order to care for these cases, it is necessary to understand this syndrome and its management. Most cases can be managed conservatively without intervention. Some cases requiring intervention may be treated using techniques within the scope of practice of the interventional nephrologists while other cases require vascular surgery. In order for the interventional nephrologists to evaluate and manage these cases in a timely and appropriate manner, practice guidelines are presented.

Discovery of a large axillary artery vascular malformation during the evaluation of a patient with hemodialysis access‐induced distal ischemia: Implications on pathophysiology and management

“…The goal of surgical revision is to provide prompt symptom resolution while preserving functional AV access 5 . A comprehensive review of the assessment of HAIDI and its management has recently been published by the American Society of Diagnostic and Interventional Nephrology 8 …”

Finger Systolic Blood Pressure Index Measurement: A Useful Tool for the Evaluation of Arterial Disease in Patients With Systemic Sclerosis

“…more reliable technique than the ankle brachial index for the diagnosis of peripheral arterial disease (PAD), especially in patients with diabetes mellitus, due to the frequent calcifications at the ankle level and to a more distal site of arterial involvement (7). Such blood measurements are also used in the upper limbs, in recent years, mostly for the prediction and evaluation of hemodialysis access-induced distal ischemia (HAIDI) (8,9).…”

Avoiding hemodialysis access–induced distal ischemia

“…A combination of other factors may contribute to the loss of arterial perfusion in the hand. 3,4 Hand ischemia may also be seen in the setting of low-flow access due to profound proximal or distal arteriosclerotic disease with a lack of adequate arterial collateral vessels and/or an incomplete palmar arch. These factors may coexist, making diagnosis and treatment of HAIDI problematic.…”