Vascular insufficiency from AV fistula: Difference between revisions
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==Background== | ==Background== | ||
*Steal syndrome = Distal hypoperfusion ischemic syndrome<ref>*Malik et Al. Understanding the dialysis access steal syndrome. A review of the etiologies, diagnosis, prevention and treatment strategies. J Vasc Access. 2008 Jul-Sep;9(3):155-66.</ref> | |||
*Higher risk with more proximal fistulas<ref>Tordoir JHM, et al. Upper extremity ischemia and hemodialysis vascular access. European journal of vascular and endovascular surgery. 2004. 27(1):1-5.</ref> | |||
**10–25% of brachiocephalic and basilic artery fistulas | |||
**4.3–6% of forearm prosthetic implants | |||
**1–1.8% of radiocephalic fistulas | |||
*Classically elderly woman with DM | |||
*Patietn history may include revascularization or banding efforts that re-stenose | |||
==Clinical Features== | ==Clinical Features== | ||
*Distal extremity becomes ischemic due shunting of arterial blood to venous side | *Distal extremity becomes ischemic due shunting of arterial blood to venous side | ||
**Exercise pain, nonhealing ulcers, cool, pulseless digits | **Exercise pain, nonhealing ulcers, cool, pulseless digits | ||
*4 Stages | |||
**Stage I: pale/blue and/or cold hand without pain | |||
**Stage II: pain during exercise and/or hemodialysis | |||
**Stage III: rest pain | |||
**Stage IV: ulcers/necrosis/gangrene | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{AV shunt complications DDX}} | {{AV shunt complications DDX}} | ||
{{Blue digit DDX}} | |||
== | ==Evaluation== | ||
** | *Initial diagnosis is clinical | ||
*Confirmation by<ref>Rutherford RB. The value of noninvasive testing before and after hemodialysis access in the prevention and management of complications. Semin Vasc Surg. 1997; 10:157–161.</ref>: | |||
**Digital blood pressure measurement | |||
**Duplex [[ultrasonography]] | |||
**Transcutaneous PO2 measurement | |||
==Management== | ==Management== | ||
*Percutaneous transluminal angioplasty (PTA) | |||
*Surgery | *Surgery | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Renal]] | |||
[[Category:Vascular]] | |||
[[Category:Surgery]] | |||
Latest revision as of 23:17, 17 October 2019
Background
- Steal syndrome = Distal hypoperfusion ischemic syndrome[1]
- Higher risk with more proximal fistulas[2]
- 10–25% of brachiocephalic and basilic artery fistulas
- 4.3–6% of forearm prosthetic implants
- 1–1.8% of radiocephalic fistulas
- Classically elderly woman with DM
- Patietn history may include revascularization or banding efforts that re-stenose
Clinical Features
- Distal extremity becomes ischemic due shunting of arterial blood to venous side
- Exercise pain, nonhealing ulcers, cool, pulseless digits
- 4 Stages
- Stage I: pale/blue and/or cold hand without pain
- Stage II: pain during exercise and/or hemodialysis
- Stage III: rest pain
- Stage IV: ulcers/necrosis/gangrene
Differential Diagnosis
AV Fistula Complications
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
Blue Digit
- Acute arterial ischemia
- Atheroembolism (AKA Blue Toe Syndrome)
- Arterial embolism
- Arterial thrombosis
- Vasospastic Disorders
- Raynaud’s disease
- Primary erythromelalgia
- Autoimmune
- Idiopathic
- Thromboangiitis obliterans (Buerger's disease)
- Chronic peripheral artery disease
- Atherosclerosis obliterans
Evaluation
- Initial diagnosis is clinical
- Confirmation by[3]:
- Digital blood pressure measurement
- Duplex ultrasonography
- Transcutaneous PO2 measurement
Management
- Percutaneous transluminal angioplasty (PTA)
- Surgery
Disposition
- Admit
See Also
External Links
References
- ↑ *Malik et Al. Understanding the dialysis access steal syndrome. A review of the etiologies, diagnosis, prevention and treatment strategies. J Vasc Access. 2008 Jul-Sep;9(3):155-66.
- ↑ Tordoir JHM, et al. Upper extremity ischemia and hemodialysis vascular access. European journal of vascular and endovascular surgery. 2004. 27(1):1-5.
- ↑ Rutherford RB. The value of noninvasive testing before and after hemodialysis access in the prevention and management of complications. Semin Vasc Surg. 1997; 10:157–161.