Hand Ischemia Associated With Dialysis Vascular Access: An Individualized Access Flow-based Approach to Therapy
Version of Record online: 15 APR 2013
© 2013 Wiley Periodicals, Inc.
Seminars in Dialysis
Volume 26, Issue 3, pages 287–314, May–June 2013
How to Cite
Beathard, G. A. and Spergel, L. M. (2013), Hand Ischemia Associated With Dialysis Vascular Access: An Individualized Access Flow-based Approach to Therapy. Seminars in Dialysis, 26: 287–314. doi: 10.1111/sdi.12088
- Issue online: 17 MAY 2013
- Version of Record online: 15 APR 2013
With the rise in the median age of hemodialysis patients, the increasing numbers of patients with multiple risk factors for vascular disease, and the efforts being made to increase the creation of autogenous arteriovenous fistulas (AVFs), dialysis access-related steal syndrome (DASS) has become a growing problem. This syndrome, caused by arterial insufficiency distal to the arteriovenous access due to diversion of blood into the access, is a potentially devastating complication. It is crucial that physicians who manage hemodialysis patients and perform vascular access procedures have a comprehensive understanding of the pathophysiology, symptoms, diagnostic maneuvers, and treatment options for DASS. The goals of management must be twofold—relieve the ischemia and preserve the access. The choice of any intervention, if such is necessary, should be based upon the clinical features presented by that individual patient; the clinical condition and prognosis of the patient, stage of the disease, location of the arterial anastomosis, and the level of blood flow within the access. This review presents information that supports an individualized, physiologic approach to this condition.