RESUMO
Although not common, hemodialysis access-induced distal ischemia is a serious condition resulting in significant hemodialysis patient morbidity. Patients with signs and symptoms suggestive of hand ischemia frequently present to the general and interventional nephrologist for evaluation. In order to care for these cases, it is necessary to understand this syndrome and its management. Most cases can be managed conservatively without intervention. Some cases requiring intervention may be treated using techniques within the scope of practice of the interventional nephrologists while other cases require vascular surgery. In order for the interventional nephrologists to evaluate and manage these cases in a timely and appropriate manner, practice guidelines are presented.
Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Mãos/irrigação sanguínea , Isquemia/terapia , Nefrologistas/normas , Padrões de Prática Médica/normas , Radiografia Intervencionista/normas , Radiologistas/normas , Diálise Renal/normas , Circulação Colateral , Consenso , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Fluxo Sanguíneo Regional , Fatores de Risco , Resultado do TratamentoRESUMO
Dialysis vascular access dysfunction is currently a huge clinical problem. We believe that comprehensive academic-based dialysis vascular access programs that go all the way from basic and translational science investigation to clinical research to a dedicated curriculum and opportunities in vascular access for nephrologists in training are essential for improving dialysis vascular access care. This paper reviews the fundamental concepts and requirements for us to move toward this vision.