Vascular insufficiency from AV fistula: Difference between revisions
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==Background== | ==Background== | ||
*Steal syndrome = Distal hypoperfusion ischemic syndrome<ref> | *Steal syndrome = Distal hypoperfusion ischemic syndrome | ||
* | *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 | *Classically elderly woman with DM | ||
==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== | ||
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==Workup== | ==Workup== | ||
* | *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 | ||
Revision as of 17:49, 13 March 2015
Background
- Steal syndrome = Distal hypoperfusion ischemic syndrome
- Higher risk with more proximal fistulas[1]
- 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
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
Workup
- Initial diagnosis is clinical
- Confirmation by[2]:
- Digital blood pressure measurement
- Duplex ultrasonography
- Transcutaneous PO2 measurement
Management
- Percutaneous transluminal angioplasty (PTA)
- Surgery
Disposition
- Admit
See Also
External Links
Sources
- ↑ 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.