Radiology, Vol 196, 697-701, Copyright © 1995 by Radiological Society of North America

ARTICLES

Hand ischemia in patients with hemodialysis access grafts: angiographic diagnosis and treatment

K Valji, RJ Hye, AC Roberts, SB Oglevie, T Ziegler and JJ Bookstein
Department of Radiology, University of California, San Diego Medical Center 92103-8756, USA.

PURPOSE: To determine the cause of symptoms and efficacy of transcatheter 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 radial artery (n = 6) and the mid- to distal brachial artery (n = 6). Transcatheter therapy was performed via the graft or by antegrade brachical puncture. RESULTS: The cause of symptoms was ischemia from obstructive arterial disease in seven cases (three with superimposed steal), graft steal alone in three, ischemic monomelic neuropathy in two, and carpal tunnel syndrome in two. Five arterial stenoses were treated with angioplasty, with improvement or resolution of symptoms in four patients. CONCLUSION: In this group, symptoms were usually the result of inflow or outflow arterial disease, alone or in combination with graft steal. Transcatheter therapy (angioplasty or embolization) is effective in selected cases.

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