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< Vol. 16 Issue 3 | May-Jun 2015 | pp. 167 - 258, e75 - e78

Preoperative duplex examination in patients with dialysis access-related hand ischemia: indication for distal radial artery ligation

Preoperative duplex examination in patients with dialysis access-related hand ischemia: indication for distal radial artery ligation

J Vasc Access 2015; 16(3): 255 - 257

Article Type: CASE REPORT

Article Subject: Dialysis

DOI:10.5301/jva.5000341

Authors

Emanuela Cordova, Laura Pettorini, Jacopo Scrivano, Matteo Baldinelli, Giorgio Punzo, Paolo Menè, Nicola Pirozzi

Abstract

To demonstrate that treatment with distal radial artery ligation (DRAL), based on preoperative evaluation with duplex ultrasound, is effective for correction of hand ischemia related to distal radiocephalic arteriovenous fistula (AVF).

Two patients with symptoms of hemodialysis access-induced distal ischemia (HAIDI) related to radiocephalic AVF at wrist (necrotic lesion of fingers, pain at rest and loss of sensory function) were studied with preoperative duplex examination. Color Doppler ultrasound (CDU) showed low-normal flux (700 and 500 mL/min respectively), retrograde flow in the DRA and increased digital perfusion after manual occlusion of DRA. They were both treated by ligation of the DRA.

Both patients had immediate improvement of ischemic symptoms. Reversed DRA flow disappeared and peripheral flow ameliorated. Postoperative AVF flow was 500 and 350 mL/min, stable at 16 and 8 months of follow-up, respectively.

Preoperative CDU examination, simulating reversed DRA flow interruption, seems to be an effective tool to predict the success of DRAL procedure.

Article History

  • • Accepted on 29/11/2014
  • • Available online on 27/01/2015
  • • Published in print on 07/05/2015

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

  • Cordova, Emanuela [PubMed] [Google Scholar] 1
  • Pettorini, Laura [PubMed] [Google Scholar] 1
  • Scrivano, Jacopo [PubMed] [Google Scholar] 1
  • Baldinelli, Matteo [PubMed] [Google Scholar] 2
  • Punzo, Giorgio [PubMed] [Google Scholar] 1
  • Menè, Paolo [PubMed] [Google Scholar] 1
  • Pirozzi, Nicola [PubMed] [Google Scholar] 1, * Corresponding Author (nicola.pirozzi1@uniroma1.it)

Affiliations

  • Nephrology Unit, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome - Italy
  • Nephrology and Dialysis Unit, INI Divisione Medicus, Tivoli - Italy

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