Difference between revisions of "Vascular insufficiency from AV fistula"

 
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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>
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**10–25% of brachiocephalic and basilic artery fistulas
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**4.3–6% of forearm prosthetic implants
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**1–1.8% of radiocephalic fistulas
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*Classically elderly woman with DM
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*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
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**Stage I: pale/blue and/or cold hand without pain
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**Stage II: pain during exercise and/or hemodialysis
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**Stage III: rest pain
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**Stage IV: ulcers/necrosis/gangrene
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{AV shunt complications DDX}}
 
{{AV shunt complications DDX}}
 +
{{Blue digit DDX}}
  
==Workup==
+
==Evaluation==
**Diagnosed by Doppler US or angiography
+
*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>:
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**Digital blood pressure measurement
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**Duplex [[ultrasonography]]
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**Transcutaneous PO2 measurement
  
 
==Management==
 
==Management==
 +
*Percutaneous transluminal angioplasty (PTA)
 
*Surgery  
 
*Surgery  
  
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==External Links==
 
==External Links==
  
==Sources==
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==References==
 
<references/>
 
<references/>
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 +
[[Category:Renal]]
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[[Category:Vascular]]
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[[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

Blue Digit

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

  1. *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.
  2. Tordoir JHM, et al. Upper extremity ischemia and hemodialysis vascular access. European journal of vascular and endovascular surgery. 2004. 27(1):1-5.
  3. 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.