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Skin ulcer due to hemodialysis access-induced distal ischemia treated with arteriovenous fistula banding and endovascular therapy
- Source :
- Journal of Cardiology Cases. 20:155-157
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- A 58-year-old woman with pallor on her left hand due to chronic hemodialysis presented with a recent intractable skin ulcer on her left 3rd finger; the skin perfusion pressure (SPP) was 19 mmHg. Preoperative angiography revealed an occluded proximal left radial artery, no communication between the ulnar and superficial palmar arteries, several collaterals from the left ulnar to the radial artery, and no visualization of the finger arteries. Successful endovascular therapy to the occluded radial artery increased flow to the arteriovenous fistula (AVF), but not to the fingertips. Slightly compressing the AVF augmented the flow and wound blush at the wound sites on the 3rd fingertip, leading to a diagnosis of hemodialysis access-induced distal ischemia (HAIDI). Surgical AVF banding with intra-operative SPP monitoring improved the SPP to 34 mmHg, leading to complete wound healing over 1 month with a preserved AVF. We performed a bilateral temporal artery biopsy and diagnosed giant cell arteritis. As the angiographic wound blush at wound sites is reportedly an important factor for wound healing, angiography with AVF manual compression is essential to diagnose HAIDI and evaluate the blood flow for wound healing.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Ischemia
Arteriovenous fistula
030204 cardiovascular system & hematology
Article
Pallor
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine.artery
medicine
cardiovascular diseases
030212 general & internal medicine
Radial artery
integumentary system
medicine.diagnostic_test
business.industry
Skin ulcer
medicine.disease
Surgery
body regions
Giant cell arteritis
Angiography
Cardiology
Hemodialysis
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 18785409
- Volume :
- 20
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiology Cases
- Accession number :
- edsair.doi.dedup.....da53be3e1fa1df1d3975d2e644a26a7c