Difference between revisions of "Vascular insufficiency from AV fistula"

(ref added)
Line 1: Line 1:
 
==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>
+
*Steal syndrome = Distal hypoperfusion ischemic syndrome
*5-10% of brachial artery fistulas
+
*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>
*1% of radial artery fistulas
+
**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
*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
 +
**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==
Line 14: Line 20:
  
 
==Workup==
 
==Workup==
*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>:
 +
**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

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

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