Obstruction in AV Fistula can cause Dialysis Patients to Lose Fingers or even a Hand

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Hemodialysis patients suffer from a serious condition called "Ischemic Hand," which not only causes significant pain and discomfort, but can also lead to necrosis (dead tissue) and the eventual loss of fingers, or even your entire hand. Recent studies have shown that the stealing of blood away from the high-resistance forearm arteries into the low-resistance arteriovenous access (retrograde flow), and stenotic lesions lead to hand ischemia. In the other cases generalized vascular calcification and diabetes is the culprit.

Patients can identify this syndrome by observing cold fingers with a pale or blue-purple discoloration. Radial pulses usually are palpable only when the arteriovenous (AV) fistula has been compressed manually. However, the volume of the radial pulse may be normal on palpation, yet the syndrome may still exists. It is for this reason that the pulse examination is helpful but not conclusive.

Treatments should start with a detailed history and physical examination to help rule out other causes of hand pain. A complete arteriogram to evaluate the circulation of the extremity is essential. The choice of treatment and procedure to apply should be based on this evaluation.

A decrease in the blood supply to the hand caused by obstruction of the blood vessels (hand ischemia), has multiple causes. The approach to therapy must be individualized on the basis of a thorough evaluation. This evaluation should include a complete imaging of the arterial circulation of the extremity. The decision on modality, surgical or percutaneous (pertains to medical procedure where access to inner tissue is done via needle puncture of the skin), and the type of procedure performed should be assessed and recommended by your healthcare team including your surgeon. KidneyBuzz.com suggests that the primary goal of your treatment should be preservation of your fingers and hand, and to accomplish that without sacrificing the access, which is your life line.

Reference: "Clinical Journal of the American Society of Nephrology." Arteriovenous Access and Hand

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