SEVERE HAND ISCHEMIA IN HEMODIALYSIS-PATIENTS EXAGGERATED BY HYPOTENSION

A 66-year-old type II diabetic man without previous history of periphe ral vascular disease developed within days after revision of a right f orearm dialysis loop graft, severe right hand ischemia culminating in a large, painful right index finger ulcer which required several month s to heal. A left forearm Cimino fistula had failed several months bef ore. Investigation of peripheral arterial circulation revealed decreas ed perfusion in both hands but not in the legs, feet, or left upper ar m. The course of hemodialysis had been characterized by symptomatic hy potension, both during dialysis and in the interdialytic periods. Seve re hand ischemia can complicate arteriovenous fistulas or grafts in di abetics on dialysis, even when evidence of peripheral arterial insuffi ciency is minimal. Hypotension may compound blood steal from an arteri ovenous fistula or graft and should be considered as a risk factor of hand ischemia.