UPPER EXTREMITY DISTAL ISCHEMIA COMPLICATING ARTERIOVENOUS FISTULA

Purpose: The development of upper extremity ischemia to an arteriovenous fistula created for hemodialysis access remains a significant complication. The aim of our study was to evaluate the surgical management of patients who developed ischemia in the upper extremity carrying the dialysis angioaccess.

Methods: Between May 1999 and April 2005, we performed 412 vascular Access procedures, and eight of them subsequently operated on due to upper extremity ischemia. There were five male and three female patients ranging in age between 26 and 56 years, with a mean age of 39,1±1,2 years.

Results: All patients with distal ischemia had brachiocephalic or brachobasilic arteriovenous fistula. Four patients were treated only ligation, three patients by ligation and brachial artery aneurysm resection. Arterial continuity was achieved end to end arterial anastomosis in one, saphenous vein interposition graft in one and PTFE graft in one patients. The remaining one patient with cephalic vein aneurysm was treated by ligation and venous aneurysm resection.

Conclusion: Complications of arteriovenous fistula, such as aneurysmatic changes, thrombosis and steal syndrome may lead to upper extremity distal ischemia. Ligation of the fistula causes improvement of the symptoms. But in patients with aneurysm, ligation should be combined with aneurismal resection and arterial continuity should be achieved. Further prospective studies will be required to demonstrate the important risk factors, and prevent or minimize the occurrence of ischemic complications. (Turkish J Vasc Surg 2006;15(1):25-30).