Operative management of distal ischemia complicating upper extremity dialysis access.

Background: Ischemia distal to a functioning arteriovenous dialysis access is an infrequent but potentially serious complication that can be difficult to manage while maintaining access patency.

Methods: Retrospective review was made of all patients requiring operative intervention for dialysis access-induced distal ischemia from 1998 to 2002 in a tertiary vascular surgery referral practice.

Results: Twelve patients had 13 hands with ischemic changes requiring intervention after placement of hemodialysis access. Ischemia was successfully treated in all cases by distal revascularization-interval ligation. Dialysis access patency was better than expected.

Conclusions: Distal revascularization-interval ligation is the optimal management for dialysis access-induced ischemia and should be attempted whenever possible.