Diagnosis and management of hemodialysis access-induced distal ischemia

AV: arteriovenous; DASS: dialysis access-related steal syndrome; PPG: photoplethysmography; IMN: ischemic monomelic neuropathy; DRAL: distal radial artery ligation; DRIL: distal revascularization interval ligation; PAI: proximalization of inflow; RUDI: revision using distal inflow.

* Symptoms can develop immediately after creation of a hemodialysis AV access or as an AV fistula matures. Early symptoms are concerning for IMN.

¶ Duplex ultrasound evaluates flow rate and patency of the brachial, radial, and ulnar arteries, and identifies the location and severity of stenosis. Duplex ultrasound and PPG can also be performed during compression of access outflow to confirm DASS before or during procedures used to treat DASS.

Δ Classify and treat DASS per algorithm for findings consistent with DASS.

◊ Dialysis patients are monitored with each session. Rarely, a patient may progress rapidly to stage IVb disease.