Abstract
A review of the Vascular Quality Initiative between 2011 and 2019. Hemodialysis-associated distal ischemia requiring intervention occurred in about 3% of patients (970/35,236) who underwent vascular access placement, although 17% developed mild ischemia not requiring intervention. Intervention included catheter-based approaches (41%), access ligation (23%), distal revascularization with interval ligation (20%), banding (13%), proximalization of arterial inflow (1.5%), and revision using distal inflow (1.4%). The median time to hemodialysis-associated distal ischemia was 7 weeks. Multivariate regression demonstrated that white race, female sex, peripheral artery disease, diabetes, prosthetic grafts, upper arm access, and target vein diameter greater than 4 mm were significantly associated with an increased risk for distal ischemia. Hemodialysis-associated distal ischemia complicates about 3% of cases and is more likely in white females with diabetes and arterial disease after upper arm prosthetic graft placement.
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