Arteriële doorbloedingsstoornissen van de hand bij 9 patiënten met een arterioveneuze fistel voor hemodialyse

To describe the treatment of hand ischaemia as a complication of arteriovenous fistulas, which have been used for haemodialysis vascular access.

Design

Retrospective.

Methods

In 1990-1998 there were in the University Hospital Maastricht, (AZM), the Netherlands, 9 patients with hand ischaemia as a complication of arteriovenous fistulas for haemodialysis. Five of these originated from the AZM, where in the same period 341 fistulas had been created. Data were collected from archives about the treatment in the 9 patients and its results.

Results

The patients were 7 women and 2 men, with a mean age of 61 years (range: 35-73). Four patients had diabetes mellitus. All patients had a high-flow AV fistula (mean flow: 1556 ml/min) at the level of the elbow. Surgical revision to diminish access flow volume was carried out in 2 patients, while fistula closure with creation of a new AV fistula was performed in 7 patients. Because of persistent ischaemia in 2 patients the access site was closed. Finger amputation was necessary in 3 patients.

Conclusion

Of all patients with new vascular accesses 1.5 developed symptomatic ischaemic complications. Two out of 9 AV fistulas could be preserved after surgical correction and in 3 patients finger amputations were carried out because of irreversible necrosis.