HAND ISCHEMIA IN PATIENTS WITH HEMODIALYSIS ACCESS GRAFTS - ANGIOGRAPHIC DIAGNOSIS AND TREATMENT

PURPOSE: To determine the cause of symptoms and efficacy of transcathe ter therapy in a series of patients with dialysis grafts and hand pain referred for arteriography. MATERIALS AND METHODS: Thirteen patients with 14 hemodialysis grafts underwent arteriography for possible hand ischemia. The sites of proximal graft anastomosis were the distal radi al artery (n = 6) and the mid- to distal brachial artery (n = 6). Tran scatheter therapy was performed via the graft or by antegrade brachica l puncture. RESULTS: The cause of symptoms was ischemia from obstructi ve arterial disease in seven cases (three with superimposed steal), gr aft steal alone in three, ischemic monomelic neuropathy in two, and ca rpal tunnel syndrome in two. Five arterial stenoses were treated with angioplasty, with improvement or resolution of symptoms in four patien ts. CONCLUSION In this group, symptoms were usually the result of infl ow or outflow arterial disease, alone or in combination with graft ste al. Transcatheter therapy (angioplasty or embolization) is effective i n selected cases.