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Arteriovenous vascular access complications
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Hemodialysis AVF, AVG access complications
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Vascular accessComplications Surveillance / Troubleshooting. presented at the Sri Lanka Society of Nephrology (SLSON) Academic Sessions 2021
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national institute of kidney disease and urology (nikdu) Dialysis access refers to the creation of an entrance way into the bloodstream so that the blood can be cleansed by the dialysis procedure. It is well established that dialysis cannot be provided without access. The attainment and maintenance of a single reliable, long-lasting dialysis access with minimal complications continue to be challenging. Achievement of such an access is associated with optimal patient clinical outcomes, superior quality of life, and minimal costs.
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Steal syndrome • Dialysis access–associated hand ischemia, “steal syndrome,” complicates 1%–20% of accesses • Is stealing سرقة of (arterial) blood which would normally flow to the palmar arch. • Common in upper arm AVFs (~4%) compared with both AVGs and forearm AVFs (~1%). • Risk factors Upper arm access Peripheral arterial disease Diabetes • Patient can complain of: Hand numbness, pain, or weakness Cold sensation and pale or cyanosis of the fingers Diminished or absent pulses Ulceration or dry gangrene of the finger tips in severe cases infection. Pt start to wear gloves in fistula hand • Examination requires comparison with the temperature, pulse, and function of the opposite hand. • Investigations Pulse oximetry Doppler flow Angiography • Differential diagnosis Carpal tunnel syndrome Peripheral vascular disease Neuropathy DM or Uremia Nerve trauma Ischemic monomelic neuropathy due to the loss of blood supply to nerves. • Treatment Options (Depending on Severity) Symptomatic coldness or paresthesia but without sensory or motor loss (e.g., gloves) Surgical, with preservation of vascular access- in "steal” effect (pain at rest) or the appearance of nonhealing ulcers: banding to reduce flow, distal revascularization–interval ligation (DRIL) procedure Surgical, with loss of vascular access- in motor loss: ligation
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Steal syndrome • Dialysis access–associated hand ischemia, “steal syndrome,” complicates 1%–20% of accesses • Is stealing سرقة of (arterial) blood which would normally flow to the palmar arch. • Common in upper arm AVFs (~4%) compared with both AVGs and forearm AVFs (~1%). • Risk factors Upper arm access Peripheral arterial disease Diabetes • Patient can complain of: Hand numbness, pain, or weakness Cold sensation and pale or cyanosis of the fingers Diminished or absent pulses Ulceration or dry gangrene of the finger tips in severe cases infection. Pt start to wear gloves in fistula hand • Examination requires comparison with the temperature, pulse, and function of the opposite hand. • Investigations Pulse oximetry Doppler flow Angiography • Differential diagnosis Carpal tunnel syndrome Peripheral vascular disease Neuropathy DM or Uremia Nerve trauma Ischemic monomelic neuropathy due to the loss of blood supply to nerves. • Treatment Options (Depending on Severity) Symptomatic coldness or paresthesia but without sensory or motor loss (e.g., gloves) Surgical, with preservation of vascular access- in "steal” effect (pain at rest) or the appearance of nonhealing ulcers: banding to reduce flow, distal revascularization–interval ligation (DRIL) procedure Surgical, with loss of vascular access- in motor loss: ligation
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Difference Between Skeletal Smooth and Cardiac Muscles
Difference Between Skeletal Smooth and Cardiac Muscles
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Arteriovenous vascular access complications
1.
Arteriovenous Vascular Access Complications Reynel
Dan Galicinao
2.
Objectives At the
end of this presentation the participants will be able to: 1.Describe the AV vascular complications 2.Assess HD patients for signs and symptoms of AV vascular complications 3.Identify ways to prevent the complications
3.
My Sundays, Tuesdays and Thursdays are
all in VEIN.
4.
AV Complications Immediately after
surgery: Hemorrhage Low venous flow Hematoma
5.
AV Complications Late complications: Infections Development
of an aneurysm and/or false aneurysm Fistula vein stenosis Congestive heart failure Steal syndrome Ischemic neuropathy Thrombosis
6.
AVF Stenosis
7.
AVG Stenosis
8.
Thrombosis
9.
Limb Ischemia in
AVF
10.
Pseudoaneurysm
11.
Access Infection
12.
Congestive Heart Failure
13.
Physical Findings with
Various Forms of Access Dysfunction