THE TREATMENT OF HAND ISCHEMIA BY ARTERIAL LIGATION AND UPPER EXTREMITY BYPASS AFTER ANGIOACCESS SURGERY

BACKGROUND: Hand ischemia remains an uncommon but potentially devastat ing complication of angioaccess operations, In the past, fistula ligat ion, arterial banding, and graft lengthening have been recommended as treatment with varying degrees of success, The procedure of arterial l igation and upper extremity bypass has recently been proposed as a mor e physiologic alternative method of treating this problem. STUDY DESIG N: The records of six patients with hand ischemia after hemodialysis a ccess surgery who were treated with arterial ligation and revasculariz ation were reviewed, Indications for operation, patient demographics, and risk factors were noted, The clinical results of surgery as well a s fistula and bypass graft patency were recorded. RESULTS: All six pat ients demonstrated marked improvement in the perfusion of the affected hand, Five of six patients had complete resolution of their symptoms, while one continues to have a mild residual numbness of the hand, All fistulas and arterial bypass grafts remain patent at a follow-up peri od of two to 18 months (mean, 7.4 months), There were no perioperative complications or deaths. CONCLUSIONS: The technique of arterial ligat ion and upper extremity bypass provides a consistent and reliable meth od of correcting hand ischemia after angioaccess surgery, We believe i t is the procedure that is most likely to alleviate the clinical sympt oms of hand ischemia without jeopardizing the long-term function of th e hemodialysis fistula.