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ASDIN : Banding of Hemodialysis Access to Treat Hand Ischemia or Cardiac Overload
Author(s) -
Van Hoek Frank,
Scheltinga Marc,
Luirink Martin,
Pasmans Huub,
Beerenhout Charles
Publication year - 2009
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2008.00537.x
Subject(s) - medicine , hemodialysis , ischemia , dialysis , hemodialysis access , perfusion , cardiology , vascular access , surgery , anesthesia
A hemodialysis access may lead to cardiac overload (CO) or hand ischemia [hemodialysis access induced distal ischemia (HAIDI). Surgical banding restricts access flow and promotes distal perfusion. Aim of the study was to investigate short‐ and long‐term clinical success of banding in these patient groups. After evaluation using a standard protocol, banding procedures ( n = 19) were performed in patients ( n = 17) with a hemodialysis access flow ≥2 l/minute or with refractory HAIDI. Various parameters including access flow, digital brachial index (DBI), and symptomatology of hand ischemia using a standard scoring system were determined before and after the operation. Surgical banding in CO patients ( n = 9) lowered access flows by 2 l (Flow preop 3.2 ± 0.3 l/minute vs. Flow postop 1.2 ± 0.1 l/minute, p < 0.001). Banding in HAIDI patients ( n = 10) increased DBI from 0.52 ± 0.08 to 0.65 ± 0.08 ( p = 0.05), whereas ischemic symptomatology was attenuated (153 ± 33 to 42 ± 15, p < 0.02). All patients successfully continued dialysis, and immediate access occlusions (<3 months) were not observed. Access flows remained at acceptable levels after a mean follow‐up of 30 months in surviving patients ( n = 11, flow: 1.0 ± 0.1 l/min). Two patients were reoperated for recurrent CO (one and 28 months postoperatively). Surgical banding monitored by measurement of flow and finger pressures is an effective short‐ and long‐term treatment modality for hemodialysis access related CO or distal ischemia.