Arterial revascularization in patients with hand pain dialyzing with upper arm Arteriovenous (AV) fistulas: A single center experience.

IF 1.6 3区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Vascular Access Pub Date : 2025-01-01 Epub Date: 2023-12-23 DOI:10.1177/11297298231214032
Saravanan Balamuthusamy, Nisha Dhanabalsamy, Manu S Bala, Prashant Reddy, Ayla Siddiqui, Manonmani Ellappan, Sowmya Gopalakrishnan, Peter Nguyen
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引用次数: 0

Abstract

Background: Distal hand ischemia syndrome (DHIS) is a well reported adverse outcome in patients with upper arm AV access. 25%-40% of these patients have been reported to be due to primary arterial disease complicated with significant arterial calcification. The effectiveness of revascularization of the distal arterial circulation on symptom resolution has not been reported yet.

Methods: Retrospective single center analysis of patients evaluated for hand/forearm pain in patients with upper arm AV access who had arterial revascularization between 01/2016 and 12/2020 were included for the analysis. Fifty-one patients met inclusion criteria. Stenotic lesions greater than 70% in the subclavian, axillary, brachial, radial, or ulnar artery were treated with balloon angioplasty. Institutional approval was obtained to review charts.

Outcomes: Successful revascularization, improvement in pain in 48 h, 1 month, and 3 months.

Results: Seventy six percent of patients had an upper arm Arteriovenous Fistula (AVF) and 24% patients had an upper arm Arteriovenous Graft (AVG). Mean access flow was 1210 (556) ml/min. 55% of patients had radial or ulnar arterial stenosis, 45% had brachial/axillary or subclavian artery stenosis. 45% patients had lesions in both radial and ulnar arteries, 88% of patients were successfully revascularized. 76% (18) of patients had improvement in symptoms within 48 h and 68% remained symptom free in 3 months. Mean DHIS stage was 3.1 before intervention and improved to 1.1 post intervention (p < 0.001). Patient satisfaction with their AV access improved from 34% to 72% (p < 0.01). Multiple regression analysis did not reveal statistically significant correlations between time on dialysis vintage and other chronic medical conditions on post procedure symptom improvement.

Conclusions: DHIS with occlusive arterial disease can be successfully revascularized to improve symptoms. Complete evaluation of the inflow arterial segment and optimal endovascular revascularization could decrease the need for access revision procedures or access abandonment.

上臂动静脉(AV)瘘透析手痛患者的动脉血管再通术:单中心经验。
背景:手部远端缺血综合征(DHIS)是上臂动静脉入路患者的一种常见不良后果。据报道,其中 25%-40% 的患者是由于原发性动脉疾病并发严重动脉钙化所致。远端动脉循环血运重建对症状缓解的效果尚未见报道:方法:对2016年1月至2020年12月期间因手部/前臂疼痛接受评估的上臂动静脉入路患者进行回顾性单中心分析。51 名患者符合纳入标准。锁骨下动脉、腋动脉、肱动脉、桡动脉或尺动脉狭窄超过 70% 的患者均接受了球囊血管成形术。审查病历已获得机构批准:结果:血管再通成功,48 小时、1 个月和 3 个月后疼痛有所改善:76%的患者患有上臂动静脉瘘(AVF),24%的患者患有上臂动静脉移植术(AVG)。平均通路流量为 1210 (556) 毫升/分钟。55%的患者患有桡动脉或尺动脉狭窄,45%患有肱动脉/腋动脉或锁骨下动脉狭窄。45%的患者桡动脉和尺动脉均有病变,88%的患者成功进行了血管再通。76%(18 人)的患者在 48 小时内症状有所改善,68%的患者在 3 个月内仍无症状。干预前的平均 DHIS 阶段为 3.1,干预后改善为 1.1(p p 结论):患有闭塞性动脉疾病的 DHIS 可通过血管重建成功改善症状。对流入动脉段进行全面评估并进行最佳的血管内再通术,可减少通路修正手术或放弃通路的需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Vascular Access
Journal of Vascular Access 医学-外周血管病
CiteScore
3.40
自引率
31.60%
发文量
181
审稿时长
6-12 weeks
期刊介绍: The Journal of Vascular Access (JVA) is issued six times per year; it considers the publication of original manuscripts dealing with clinical and laboratory investigations in the fast growing field of vascular access. In addition reviews, case reports and clinical trials are welcome, as well as papers dedicated to more practical aspects covering new devices and techniques. All contributions, coming from all over the world, undergo the peer-review process. The Journal of Vascular Access is divided into independent sections, each led by Editors of the highest scientific level: • Dialysis • Oncology • Interventional radiology • Nutrition • Nursing • Intensive care Correspondence related to published papers is also welcome.
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