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Minerva Cardioangiologica 2016 Jun 17


language: English

Angiographic study of upper limb vascularization in a large cohort of hemodialysis patients with critical hand ischemia

Roberto FERRARESI 1, Jorge ACUNA-VALERIO 2, Matteo FERRARIS 3, Marco FRESA 3, Meneme HAMADE 3, Gian B. DANZI 4, Roberto GANDINI 5, Giovanni MAURI 6, 7

1 Peripheral Interventional Unit, Humanitas Gavazzeni, Bergamo, Italy; 2 Program in Medical Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico; 3 Vascular Surgery, Humanitas Gavazzeni, Bergamo, Italy; 4 Cardiovascular Department, Santa Corona Hospital, Pietra Ligure, Savona, Italy; 5 Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy and Nuclear Medicine, IRCCS Fondazione Policlinico di Tor Vergata, Rome, Italy; 6 Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; 7 Division of Interventional Radiology, European Institute of Oncology, Milan, Italy


BACKGROUND: Critical hand ischemia (CHI) is a not rare condition in patients with end-stage- renal-disease on hemodialysis (HD), and presents devastating consequences due to its impact on life quality. In HD patients CHI may be related to three main conditions: obstruction of the big upper limb arteries, obstruction of the small hand and finger arteries, and the steal effect of a hemodialysis access. The aim of this study is to describe the angiographic pattern of upper limb vascularization and associated cardiovascular risk factors, in a large cohort of consecutive HD patients with CHI studied in our center.
METHODS: 114 HD consecutive patients (age 64±10 years) with a total of 132 upper limbs affected by CHI (21 with rest pain and 93 with tissue loss) underwent angiography in our center. The majority of them were diabetic males. We computed the prevalence of obstructive disease for each vascular segment of the upper limb.
RESULTS: Above-the-elbow arteries were mostly spared, while below-the-elbow and hand arteries were extensively affected. We found a stenosis or occlusion in humeral artery (2.3%), radial (61.4%) or ulnar (90.1%) arteries, deep palmar arch (51.5%), superficial palmar arch (58.3%) and digital arteries (72.4%). In 42,4% of cases an ipsilateral functioning arteriovenous fistula was present.
CONCLUSIONS: CHI in HD patients is a result of below-the-elbow and hand vessel obstruction and is not primarily related to dialysis access.

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