AI Article Synopsis
- A portion of haemodialysis patients experience hand ischaemia (HAIDI), and the study investigates links between the type of arteriovenous access (AVA) and the timing/severity of HAIDI.
- In a review of 21 studies with 464 patients, acute HAIDI was mostly seen with non-autogenous AVA (88%), while chronic HAIDI was predominantly linked to autogenous AVA using the brachial artery (91%).
- The findings suggest that acute hand ischaemia usually relates to grafts rather than autogenous access, and choosing an autogenous AVA might be beneficial for patients with risk factors for acute HAIDI, despite its association with chronic HAIDI.
Article Abstract
Background: A small portion of haemodialysis patients develop hand ischaemia (HAIDI, haemodialysis access-induced distal ischaemia) in the presence of an arteriovenous access (AVA). It is unknown if the time of onset of ischaemia is related to the type of AVA. This review aims to investigate if a relationship is present between the type of AVA and the time of onset and intensity of HAIDI.
Methods: Standard databases and reference lists of the pertinent literature were systematically searched. HAIDI was classified as 'acute' (<24 h after routine access construction), 'subacute' (within 1 month) or 'chronic' (>1 month). Location, type and follow-up of AVA were tabulated.
Results: Twenty-one studies reporting on surgically or percutaneously corrected HAIDI patients (n = 464) fulfilled the inclusion criteria. Acute HAIDI strongly (88%) correlated with non-autogenous AVA. In contrast, chronic HAIDI was predominantly (91%) observed following autogenous AVA based on the cubital segment of the brachial artery. A simple clinical classification for chronic HAIDI guiding treatment strategies is proposed.
Conclusions: Hand ischaemia occurring early after routine access surgery is usually related to grafts and not to autogenous access construction. If patients have several risk factors for acute hand ischaemia (diabetes), nephrologists and vascular surgeons may choose an autogenous AVA. A disadvantage of an autogenous access is its association with chronic hand ischaemia, particularly if constructed with a brachial artery.
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| http://dx.doi.org/10.1093/ndt/gfp200 | DOI Listing |
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