Banding of hemodialysis access to treat hand ischemia or cardiac overload.

Abstract:

:A hemodialysis access may lead to cardiac overload (CO) or hand ischemia [hemodialysis access induced distal ischemia (HAIDI). Surgical banding restricts access flow and promotes distal perfusion. Aim of the study was to investigate short- and long-term clinical success of banding in these patient groups. After evaluation using a standard protocol, banding procedures (n = 19) were performed in patients (n = 17) with a hemodialysis access flow > or =2 l/minute or with refractory HAIDI. Various parameters including access flow, digital brachial index (DBI), and symptomatology of hand ischemia using a standard scoring system were determined before and after the operation. Surgical banding in CO patients (n = 9) lowered access flows by 2 l (Flow(preop) 3.2 +/- 0.3 l/minute vs. Flow(postop) 1.2 +/- 0.1 l/minute, p < 0.001). Banding in HAIDI patients (n = 10) increased DBI from 0.52 +/- 0.08 to 0.65 +/- 0.08 (p = 0.05), whereas ischemic symptomatology was attenuated (153 +/- 33 to 42 +/- 15, p < 0.02). All patients successfully continued dialysis, and immediate access occlusions (<3 months) were not observed. Access flows remained at acceptable levels after a mean follow-up of 30 months in surviving patients (n = 11, flow: 1.0 +/- 0.1 l/min). Two patients were reoperated for recurrent CO (one and 28 months postoperatively). Surgical banding monitored by measurement of flow and finger pressures is an effective short- and long-term treatment modality for hemodialysis access related CO or distal ischemia.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

van Hoek F,Scheltinga M,Luirink M,Pasmans H,Beerenhout C

doi

10.1111/j.1525-139X.2008.00537.x

subject

Has Abstract

pub_date

2009-03-01 00:00:00

pages

204-8

issue

2

eissn

0894-0959

issn

1525-139X

pii

SDI537

journal_volume

22

pub_type

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