Hand ischemia in patients with hemodialysis access grafts: angiographic diagnosis and treatment

Radiology. 1995 Sep;196(3):697-701. doi: 10.1148/radiology.196.3.7644631.


Purpose: To determine the cause of symptoms and efficacy of transcatheter therapy in a series of patients with dialysis grafts and hand pain referred for arteriography.

Materials and methods: Thirteen patients with 14 hemodialysis grafts underwent arteriography for possible hand ischemia. The sites of proximal graft anastomosis were the distal radial artery (n = 6) and the mid- to distal brachial artery (n = 6). Transcatheter therapy was performed via the graft or by antegrade brachical puncture.

Results: The cause of symptoms was ischemia from obstructive arterial disease in seven cases (three with superimposed steal), graft steal alone in three, ischemic monomelic neuropathy in two, and carpal tunnel syndrome in two. Five arterial stenoses were treated with angioplasty, with improvement or resolution of symptoms in four patients.

Conclusion: In this group, symptoms were usually the result of inflow or outflow arterial disease, alone or in combination with graft steal. Transcatheter therapy (angioplasty or embolization) is effective in selected cases.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical
  • Angioplasty, Balloon
  • Arterial Occlusive Diseases / complications
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / therapy
  • Blood Vessel Prosthesis / adverse effects*
  • Brachial Artery / diagnostic imaging
  • Brachial Artery / surgery
  • Carpal Tunnel Syndrome / complications
  • Catheters, Indwelling / adverse effects*
  • Embolization, Therapeutic
  • Female
  • Follow-Up Studies
  • Hand / blood supply*
  • Hand / innervation
  • Humans
  • Ischemia / diagnostic imaging*
  • Ischemia / etiology*
  • Ischemia / therapy
  • Male
  • Middle Aged
  • Peripheral Nervous System Diseases / complications
  • Punctures
  • Radial Artery / diagnostic imaging
  • Radial Artery / surgery
  • Radiography
  • Regional Blood Flow
  • Renal Dialysis / instrumentation*
  • Retrospective Studies