Division of Nephrology and Hypertension, The Thomas Ordway Distinguished Professor of Medicine, DCI Albany, New York, Albany Medical College, Albany, NY.
Department of Medicine, Jersey Shore University Medical Center, Hackensack-Meridian School of Medicine at Seton Hall University, Hackensack-Meridian Health, Neptune, NJ.
Adv Chronic Kidney Dis. 2020 May;27(3):208-213. doi: 10.1053/j.ackd.2020.03.008.
Hand ischemia is a relatively common complication of hemodialysis arteriovenous (AV) access. Clinical manifestations frequently start with pale and cold ipsilateral hand. Symptoms can progress to pain during dialysis and can eventually lead to tissue necrosis and gangrene if not addressed in a timely fashion. Comprehensive physical examination of the hand, AV access, and comparing it with the contralateral hand will assist in differentiating hand ischemia from carpal tunnel syndrome, osteoarthritis of the hand, and others. There are several treatment options for hand ischemia based on the severity of symptoms. Conservative management with careful monitoring can be applied in early stages. However, if symptoms persist or worsen, a full arteriogram of the ipsilateral extremity should be performed to evaluate for the presence of arterial stenosis. Angioplasty of the arterial stenosis, if present, will frequently lead to the resolution of symptoms. There are several percutaneous and surgical treatment options for hand ischemia, if no arterial stenosis was found or angioplasty does not relieve symptoms. We discuss in this article these treatment options in detail. Treatment goal is to improve hand ischemia symptoms while maintaining hemodialysis AV access and preserving patient's hand. Access ligation remains a treatment of last resort.
手部缺血是血液透析动静脉（AV）通路的一种相对常见的并发症。临床表现常始于同侧手部苍白和冰冷。症状可在透析过程中加重，并最终导致组织坏死和坏疽，如果不及时处理。对手、AV 通路进行全面体格检查，并与对侧手进行比较，有助于将手部缺血与腕管综合征、手部骨关节炎等相鉴别。根据症状的严重程度，有几种治疗手部缺血的方法。在早期，可以采用保守治疗并密切监测。然而，如果症状持续或恶化，应进行同侧肢体的全动脉造影，以评估是否存在动脉狭窄。如果存在动脉狭窄，血管成形术通常会导致症状缓解。如果没有发现动脉狭窄或血管成形术不能缓解症状，有几种经皮和手术治疗手部缺血的方法。我们在本文中详细讨论了这些治疗方法。治疗目标是改善手部缺血症状，同时保持血液透析 AV 通路并保留患者的手部。通路结扎仍然是最后的治疗手段。
