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Change in skin perfusion pressure after the creation of upper limb arteriovenous fistula for maintenance hemodialysis access
Author(s) -
Sueki Shina,
Sakurada Tsutomu,
Miyamoto Masahito,
Tsuruoka Kayori,
Matsui Katsuomi,
Sato Yuichi,
Shibagaki Yugo,
Kimura Kenjiro
Publication year - 2014
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12219
Subject(s) - medicine , arteriovenous fistula , hemodialysis , perfusion , blood pressure , cardiology , ultrasound , blood flow , upper limb , surgery , radiology
Arteriovenous fistula ( AVF ) is the most important vascular access method for hemodialysis ( HD ). However, ischemic steal syndrome occasionally develops. This study evaluated the change in skin perfusion pressure ( SPP ) after the creation of upper limb AVF and analyzed the relationship between blood flow measurements and the change in SPP . The subjects included 21 patients who underwent radiocephalic AVF creation for the first time between N ovember 2012 and S eptember 2013. We measured SPP on the palm side of the third finger of both hands and assessed blood flow measurements using ultrasound examination before and after the creation of AVF . The subjects consisted of 15 men and 6 women (average age: 65.3 ± 12.7 years, including 12 diabetic patients). Observational period between before and after surgery was 4.9 ± 5.2 days. None of the patients had ischemic steal syndrome after the creation of AVF . Skin perfusion pressure tended to decrease after creation of AVF on the finger of AVF side (100.0 ± 20.9 vs. 87.9 ± 26.5 mmHg, P = 0.063). In contrast, SPP did not change in the limb without AVF (97.9 ± 20.7 vs. 101.0 ± 19.4 mmHg, P = 0.615). The rate of change in SPP was significantly decreased on the finger of AVF side compared with that of limb without AVF (0.055% vs. −0.112%, P = 0.014). There was no correlation between the change in SPP and blood flow measurements. Skin perfusion pressure is possible to detect ischemic steal syndrome after the creation of upper limb AVF .