Vascular insufficiency from AV fistula: Difference between revisions
Neil.m.young (talk | contribs) (ref added) |
Neil.m.young (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Steal syndrome = Distal hypoperfusion ischemic syndrome | *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> | ||
*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> | *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 | **10–25% of brachiocephalic and basilic artery fistulas | ||
| Line 6: | Line 6: | ||
**1–1.8% of radiocephalic fistulas | **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== | ||
Revision as of 17:56, 13 March 2015
Background
- Steal syndrome = Distal hypoperfusion ischemic syndrome[1]
- Higher risk with more proximal fistulas[2]
- 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
- Patietn history may include revascularization or banding efforts that re-stenose
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[3]:
- Digital blood pressure measurement
- Duplex ultrasonography
- Transcutaneous PO2 measurement
Management
- Percutaneous transluminal angioplasty (PTA)
- Surgery
Disposition
- Admit
See Also
External Links
Sources
- ↑ *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.
- ↑ 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.