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Diehl L, Johansen K, Watson J. Operative management of distal ischemia complicating upper extremity dialysis access. American journal of surgery. 2003 Jul 1; 186(1):17-9.
BACKGROUND: Ischemia distal to a functioning arteriovenous dialysis access is an infrequent but potentially serious complication that can be difficult to manage while maintaining access patency. METHODS: Retrospective review was made of all patients requiring operative intervention for dialysis access-induced distal ischemia from 1998 to 2002 in a tertiary vascular surgery referral practice. RESULTS: Twelve patients had 13 hands with ischemic changes requiring intervention after placement of hemodialysis access. Ischemia was successfully treated in all cases by distal revascularization-interval ligation. Dialysis access patency was better than expected. CONCLUSIONS: Distal revascularization-interval ligation is the optimal management for dialysis access-induced ischemia and should be attempted whenever possible.