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Background: Hand ischemia remains an uncommon but potentially devastating complication of angioaccess operations. In the past, fistula ligation, arterial banding, and graft lengthening have been recommended as treatment with varying degrees of success. The procedure of arterial ligation and upper extremity bypass has recently been proposed as a more physiologic alternative method of treating this problem., Study Design: The records of six patients with hand ischemia after hemodialysis access surgery who were treated with arterial ligation and revascularization were reviewed. Indications for operation, patient demographics, and risk factors were noted. The clinical results of surgery as well as fistula and bypass graft patency were recorded., Results: All six patients demonstrated marked improvement in the perfusion of the affected hand. Five of six patients had complete resolution of their symptoms, while one continues to have a mild residual numbness of the hand. All fistulas and arterial bypass grafts remain patent at a follow-up period of two to 18 months (mean, 7.4 months). There were no perioperative complications or deaths., Conclusions: The technique of arterial ligation and upper extremity bypass provides a consistent and reliable method of correcting hand ischemia after angioaccess surgery. We believe it is the procedure that is most likely to alleviate the clinical symptoms of hand ischemia without jeopardizing the long-term function of the hemodialysis fistula.

Background: Patients with limb ischemia and diffuse aortoiliac or combined aortoiliac and femoropopliteal disease present as a difficult problem for surgeons. This study was done to determine whether or not angioplasty can be successfully used as a prelude to distal bypass in patients with multilevel arterial occlusive disease., Study Design: This is a retrospective review of an entire hospital experience with iliac angioplasty used as a prelude to distal arterial bypass. Kaplan-Meier life table analysis was performed and comparisons were made using log rank method., Results: During a six year period, 37 patients underwent percutaneous iliac angioplasty before distal arterial reconstruction. Subsequent arterial reconstructions included femorofemoral bypass in nine patients, femoropopliteal bypass in 25 patients, femorotibial bypass in two patients, and common femoral endarterectomy in the remaining patient. The primary graft patency rate was 81 percent at five years. The overall success of iliac angioplasty was 76 percent at five years. Limb salvage was achieved in 78 percent of the patients with threatened extremities, and there was no perioperative mortality., Conclusions: Iliac angioplasty can successfully be used as a prelude to distal arterial bypass in patients with multilevel disease. The rate of angioplasty failure is low and grafts often remain patent in the face of early hemodynamic inflow failure, allowing salvage by operation or repeat dilatation. Close follow-up evaluation will allow early detection and appropriate correction of changes in inflow hemodynamics that occur before graft closure.

During a nine year period, the authors treated 37 patients with angiographic catheter induced arterial occlusions. Twenty-nine patients presented with acutely ischemic extremities requiring urgent intervention. Arterial thrombosis followed transfemoral cardiac catheterization or angioplasty in 13 patients, transbrachial catheterization in 13 and peripheral angiography or angioplasty in three. Primary arterial repair was sufficient to restore adequate distal perfusion in 23 patients; however, four required femorofemoral bypass and two required axillofemoral grafts to restore adequate distal perfusion. There were two perioperative deaths and no patient required amputation. Eight patients presented weeks to months after arterial injury. Two patients were minimally symptomatic and were treated without operation. Six patients had significant ischemic symptoms and required arterial bypass operation. All grafts have remained patent during a follow-up period ranging from 18 months to seven years (mean of 28 months). Appropriately planned and executed operative therapy is effective in preventing limb loss and functional impairment in patients with arterial thrombosis after angiographic procedures.