Approach to Patient with Arteriovenous Access Presenting with Hand Pain

2021 ◽  
pp. 127-139
Author(s):  
Chieh Suai Tan ◽  
Diego A. Covarrubias ◽  
Steven Wu
Keyword(s):  
Hand Pain ◽  
Arteriovenous Access

Approach to Patient with Arteriovenous Access Presenting with Hand Pain

2013 ◽  
pp. 119-130 ◽  
Author(s):  
Chieh Suai Tan ◽  
Diego A. Covarrubias ◽  
Steven Wu
Keyword(s):  
Hand Pain ◽  
Arteriovenous Access

Leitlinie Karpaltunnelsyndrom

2020 ◽  
Vol 24 (02) ◽  
pp. 54-54
Author(s):  
Arne Vielitz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Sensory Deficits ◽  
Hand Pain ◽  
Tunnel Syndrome

Erickson M, Lawrence M, Jansen CWS et al. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome. J Orthop Sports Phys Ther 2019; 49: CPG1–CPG85. doi: 10.2519/jospt.2019.0301

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

2020 ◽  
Vol 3 (2) ◽  
pp. 147-150
Author(s):  
Kaczynski RE ◽  
Asaad Y ◽  
Valentin-Capeles N ◽  
Battista J
Keyword(s):  
Arteriovenous Fistula ◽  
Complete Loss ◽  
Dialysis Access ◽  
Loss Of Function ◽  
Access Site ◽  
Surgical Ligation ◽  
Arteriovenous Access ◽  
Vascular Steal ◽  
Steal Syndrome

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

scholarly journals Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors

2021 ◽  
pp. 112972982096506
Author(s):  
Eva Chytilova ◽  
Tamara Jemcov ◽  
Jan Malik ◽  
Jernej Pajek ◽  
Branko Fila ◽  
...  
Keyword(s):  
Vascular Access ◽  
Doppler Ultrasonography ◽  
Arteriovenous Graft ◽  
Central Venous ◽  
Preoperative Mapping ◽  
High Incidence ◽  
Arteriovenous Access ◽  
Ultrasound Parameters ◽  
Fistula Maturation

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

Exteriorized chronic aorto‐caval arteriovenous access shunts in the baboon ( Papio cynocephalus )

1993 ◽  
Vol 22 (6) ◽  
pp. 331-339
Author(s):  
Arie Bass ◽  
William C. Krupski ◽  
Stephen R. Hanson ◽  
Thomas Dodson ◽  
Alan Lumsden ◽  
...  
Keyword(s):  
Papio Cynocephalus ◽  
Arteriovenous Access

Changes in duplex ultrasound parameters during maturation according to arteriovenous access types in incident hemodialysis patients

2021 ◽  
pp. 112972982110052
Author(s):  
Jae Jin Lee ◽  
Sun Ryoung Choi ◽  
Eun Ju Lee ◽  
Ha Youn Yang ◽  
Seon Ha Baek ◽  
...  
Keyword(s):  
Pulsatility Index ◽  
Significant Positive Correlation ◽  
Duplex Ultrasound ◽  
Hemodialysis Patients ◽  
Hemodynamic Parameters ◽  
Positive Correlation ◽  
Arteriovenous Access ◽  
Artery Flow ◽  
Ultrasound Parameters ◽  
Av Graft

Background: Little is known about the changes in hemodynamic parameters during arteriovenous (AV) access maturation using duplex ultrasound according to radiocephalic fistula (RCF), brachiocephalic fistula (BCF), and AV graft (AVG) in incident hemodialysis (HD) patient. The objective of this study was to evaluate changes and differences in brachial artery flow rate (BAFR) and related parameters affecting maturation by duplex ultrasound in incident HD patients according to access type. Methods: This study was an observational study conducted from March 2019 to October 2020. During the study period, 109 incident patients underwent new AV access creation, of which 100 were included in the study. The duplex ultrasound was performed on the day prior to access creation, further, day 1, 2 weeks, and 4 weeks later after access creation in incident HD patients. Results: Among all the patients, 38 (38%) received BCF, while 26 (26%) underwent RCF. Of the patients with AVG, 18 (50%) had a forearm loop AVG. The overall mean age was 62.2 ± 13.8 years (range, 32–89). The BAFR increased about 6.9 times in the RCF, 17.4 times in the BCF, and 19.5 times in the AVG at day 1. The median BAFR measured on day 1 was 580.4 mL/min for RC, 1029.0 mL/min for BC, and 1133.0 mL/min for AVG. Relative to the values measured in week 4, the BAFR on day 1 was 69.5% in RCF, 90.6% in BCF, and 93.9% in AVG. The acceleration decreased most significantly on day 1( p < 0.05). The acceleration time increased significantly on day 1 ( p < 0.05) and beyond during maturation in the RCF and BCF. The BAFR of the RCF had a significantly negative correlation with the pulsatility index. The BAFR of the BCF showed a significantly positive correlation with the systolic and diastolic blood pressure but negatively correlated with pulse rate. The BAFR of the AVG showed a significant positive correlation with the diameter of the outflow vein. Conclusions: There were differences in the clinical and duplex parameters during maturation according to access type. The most dramatic changes of duplex parameters were on the day after AV access creation regardless of AV access types. Though RCF had a lower BAFR rate compared to BCF and AVG, it already had a sufficient BAFR required for adequate HD treatment the day after creation. The BAFR of BCF was not different from that of AVG.

scholarly journals Clinical and cost effectiveness of arthritis gloves in rheumatoid arthritis (A-GLOVES): randomised controlled trial with economic analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alison Hammond ◽  
Yeliz Prior ◽  
Sarah Cotterill ◽  
Chris Sutton ◽  
Elizabeth Camacho ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Recent Change ◽  
Control Group ◽  
Dominant Hand ◽  
Night Time ◽  
Hand Pain ◽  
Randomised Controlled

Abstract Background Arthritis (or compression) gloves are widely prescribed to people with rheumatoid arthritis and other forms of hand arthritis. They are prescribed for daytime wear to reduce hand pain and improve hand function, and/or night-time wear to reduce pain, improve sleep and reduce morning stiffness. However, evidence for their effectiveness is limited. The aims of this study were to investigate the clinical and cost effectiveness of arthritis gloves compared to placebo gloves on hand pain, stiffness and function in people with rheumatoid arthritis and persistent hand pain. Methods A parallel randomised controlled trial, in adults (≥ 18 years) with rheumatoid or undifferentiated inflammatory arthritis at 16 National Health Service sites in the UK. Patients with persistent hand pain affecting function and/or sleep were eligible. Randomisation (1:1) was stratified by recent change (or not) in medication, using permuted blocks of random sizes. Three-quarter-finger length arthritis gloves (Isotoner®: applying 23-32 mmHg pressure) (intervention) were compared to loose-fitting placebo gloves (Jobskin® classic: providing no/minimal pressure) (control). Both gloves (considered to have similar thermal qualities) were provided by occupational therapists. Patients and outcome assessors were blinded; clinicians were not. The primary outcome was dominant hand pain on activity (0–10) at 12 weeks, analysed using linear regression and intention to treat principles. Results Two hundred six participants were randomly assigned (103 per arm) and 163 (84 intervention: 79 control) completed 12-week follow-up. Hand pain improved by 1.0 (intervention) and 1.2 (control), an adjusted mean difference of 0.10 (95% CI: − 0.47 to 0.67; p = 0.72). Adverse events were reported by 51% of intervention and 36% of control group participants; with 6 and 7% respectively, discontinuing glove wear. Provision of arthritis gloves cost £129, with no additional benefit. Conclusion The trial provides evidence of no clinically important effect of arthritis gloves on any of the trial outcomes (hand pain, function and stiffness) and arthritis gloves are not cost-effective. The clinical and cost-effectiveness results support ceasing provision of arthritis gloves in routine clinical practice. Funding: National Institute for Health Research. Trial registration ISRCTN, ISRCTN25892131; Registered 05/09/2016: retrospectively registered.

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