Surgical treatment of hand ischaemia in patients with arteriovenous fistula

Abstract

Background. Hand ischaemia symptoms following the creation of arteriovenous fistulas for haemodialysis occur in the case of 3–5% of patients. The aim of this paper is to assess various methods of hand ischaemia treatment in patients with arteriovenous fistulas created for haemodialysis.
Material and methods. There were 42 persons who underwent operations between 1990 and 2002. There were 20 cases of ischaemic necrosis in the area of fingers. Twenty two patients reported pain which was becoming more acute during dialysis. In 9 cases, distal arterial ligation was made. Arterial anastomosis with prosthesis band was performed in 16 cases whereas arterial ligation-bypass was applied in 14 cases.
Results. In the case of 3 patients we had to ligate a fistula and create a new one. In the group of the remaining 39 patients hand blood supply improved and ischaemic symptoms were relieved. Within follow-up, thrombosis occurred in 7 patients (banding group).
Conclusions. In patients with hand ischaemia symptoms one should always try, once the arteriovenous fistula is created, to improve the blood supply condition and, at the same time, keep anastomosis patent.