Digital pressure and oxygen saturation measurements in the diagnosis of chronic hemodialysis access-induced distal ischemia

Modaghegh, M. H. S. and Roudsari, B. and Hafezi, S. (2015) Digital pressure and oxygen saturation measurements in the diagnosis of chronic hemodialysis access-induced distal ischemia. Journal of Vascular Surgery, 62 (1). pp. 135-142.

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Objective Hemodialysis access-induced distal ischemia (HAIDI) can be classified as acute (on the first postoperative day), subacute (≤1 month), or chronic (>1 month), based on the time of onset after access creation. The diagnosis is mainly clinical. However, performing additional tests is beneficial in further assessment of patients. The purpose of this study was to evaluate the use of finger pressure and oxygen saturation measurements for the diagnosis of chronic HAIDI. Methods A total of 20 patients with chronic HAIDI (cases) and 40 asymptomatic hemodialysis patients (controls) were matched for age, sex, etiology of end-stage renal disease, and type of arteriovenous access. Basal digital pressure (BDP), digital pressure during manual compression of access, digital brachial index (DBI), change in digital pressure with access compression (CDP), digital pressure of the contralateral side, and bilateral oxygen saturation (O<inf>2</inf> Sat) were measured in all patients. Results In the case group, compression of the arteriovenous fistula (AVF) increased mean BDP from 61 ± 26 to 118 ± 28 mm Hg (P <.001), which failed to reach the non-AVF side mean digital pressure of 151 ± 25 mm Hg (P <.001). In addition, O<inf>2</inf> Sat of the AVF side was significantly lower than the contralateral side (92.9 ± 2.1 vs 95.6 ± 1.4; P =.001). Among the controls, manual AVF compression raised the mean BDP from 114 ± 36 mm Hg to 133 ± 29 mm Hg (P <.001), which was still significantly lower than the contralateral side mean digital pressure of 141 ± 30 mm Hg (P =.002). In addition, O<inf>2</inf> Sat values of the two sides were different (96.7 ± 2.1 vs 97.1 ± 1.9; P =.01). Comparing the cases and controls, the mean BDP (61 ± 26 mm Hg vs 114 ± 36 mm Hg; P <.001), DBI (0.44 ± 0.16 vs 0.82 ± 0.19; P <.001), and O<inf>2</inf> Sat (92.9 ± 2.1 vs 96.7 ± 2.1; P <.001) were significantly lower and CDP (57 ± 24 mm Hg vs 19 ± 17 mm Hg; P <.001) was significantly higher in the cases than in the controls. The optimal discriminatory thresholds of 80 mm Hg for BDP, 0.7 for DBI, 40 mm Hg for CDP, and 94 for O<inf>2</inf> Sat were determined. Conclusions Digital pressure and O<inf>2</inf> Sat measurements are useful additional methods to assist in the clinical evaluation of hemodialysis patients with access-related hand ischemia. BDP <80 mm Hg, DBI <0.7, CDP >40 mm Hg, and O<inf>2</inf> Sat <94 are associated with chronic HAIDI. © 2015 Society for Vascular Surgery.

Item Type: Article
Additional Information: Cited By :12 Export Date: 16 February 2020 CODEN: JVSUE Correspondence Address: Hafezi, S.; Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical SciencesIran
Uncontrolled Keywords: adult arteriovenous shunt Article basal digital pressure case control study chronic hemodialysis access induced distal ischemia clinical article cold sensation controlled study cyanosis diabetes mellitus digital brachial index digital pressure measurement end stage renal disease female follow up hand pain hand paresthesia hemodialysis patient human hypertension limb ischemia limb weakness male middle aged musculoskeletal system examination musculoskeletal system parameters oxygen saturation pressure measurement priority journal vascular access adverse effects blood blood pressure blood pressure measurement hand ischemia Kidney Failure, Chronic oximetry pathophysiology photoelectric plethysmography predictive value procedures renal replacement therapy severity of illness index time treatment outcome vascularization biological marker oxygen Arteriovenous Shunt, Surgical Biological Markers Blood Pressure Determination Case-Control Studies Humans Photoplethysmography Predictive Value of Tests Renal Dialysis Time Factors
Subjects: WJ Urogenital System
Divisions: Mashhad University of Medical Sciences
Depositing User: mr lib5 lib5
Date Deposited: 04 May 2020 08:02
Last Modified: 04 May 2020 08:02

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