Contemporary outcomes of distal radial artery ligation for access related hand ischemia.

• Tác giả: James J Fitzgibbon, Patrick Heindel, Dirk M Hentschel, Mohamad A Hussain, Charles Keith Ozaki
• Ngôn ngữ: eng
• Ký hiệu phân loại: 651.3743 Office management
• Thông tin xuất bản: United States : The journal of vascular access , 2025
• Bộ sưu tập: NCBI
• ID: 581844

Tóm tắt

 OBJECTIVES: Access related hand ischemia (ARHI) is a rare albeit morbid complication of hemodialysis access creation. Distal radial artery ligation (DRAL) has been described as a strategy to improve perfusion to the hand while maintaining the access. The objective of this study was to report longitudinal outcomes of DRAL for ARHI. METHODS: Retrospective cohort study (2015-2021) of all patients who underwent DRAL for ARHI at a tertiary care vascular center. Subjects were identified using the Mass General Brigham clinical data warehouse and data collection was supplemented with chart adjudication. Outcomes captured included 30-day complications and improvement in ARHI-related symptoms at 1 year. RESULTS: Thirty-one patients were included. Mean (SD) age was 59.9 (14.5) and 67.7% were male. Wrist radial-cephalic (74.2%) and proximal radial-cephalic (9.7%) configurations were most common. ARHI severity was: 9.7% stage 1 (retrograde flow without symptoms)
  38.7% stage 2 (pain during exercise or dialysis)
  41.9% stage 3 (pain at rest)
  and 9.7% stage 4 (tissue loss). High flow was present in 35.5% of patients at baseline with median (IQR) flow of 1670 ml/min (1478-1954). After DRAL, median (IQR) flow reduction in the high flow group was 953 ml/min (645-993)
  concurrent precision banding was performed in 29% to reduce flow. The 30-day risk of complication was 3.2% ( CONCLUSION: Distal radial artery ligation for ARHI is safe and can improve ischemic symptoms in most patients while salvaging access function. Precision banding can serve as a useful adjunct in high flow accesses. Carpal tunnel syndrome should be considered as part of the differential diagnosis of hand pain in this population.