کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
2867310 1171081 2016 11 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Síndrome isquémico de la mano secundario a acceso vascular para hemodiálisis. Estrategias terapéuticas
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی کاردیولوژی و پزشکی قلب و عروق
پیش نمایش صفحه اول مقاله
Síndrome isquémico de la mano secundario a acceso vascular para hemodiálisis. Estrategias terapéuticas
چکیده انگلیسی
Access-induced ischemia is an uncommon but devastating complication for patients maintained on hemodialysis. The construction of an arteriovenous access results in a predictable decrease in the perfusion pressure distal to the anastomosis, which can result in ischemia if the compensatory mechanisms are inadequate. Because many of the signs and symptoms are nonspecific, the diagnosis can be aided in equivocal cases with non-invasive vascular laboratory studies. A digital/brachial index < 0.45 is suggestive of severe ischemic syndrome, and is usually associated with pain at rest and/or trophic lesions on the fingers. The aims of the treatments are to reverse the hand ischemia and to preserve the access. There are a variety of treatments, including correction of the inflow lesion, access ligation, limiting the flow through the access (banding), distal revascularization with interval ligation (DRIL), revision using distal inflow (RUDI), or proximalization of arterial inflow (PAI). The optimal choice should be based on hemodynamic mechanisms and severity of symptoms, in conjunction with the access type and patient comorbidities. A review of the underlying pathophysiology and treatment options will be presented. To date, the DRIL procedure has been the most consistently successful strategy. However, the particular circumstances of each case demand an individualization of treatment.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Angiología - Volume 68, Issue 4, July–August 2016, Pages 311-321
نویسندگان
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