Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms of distal limb ischemia in the extremity ipsilateral to the AV access. Symptoms include coldness, paresthesia, and pain exacerbated during hemodialysis sessions. Patient reports motor weakness and sensory deficits in the hand. No history of prior access revision or peripheral vascular disease.
Clinical Examination Findings
Physical exam reveals a cool, pale distal extremity compared to the contralateral side. Capillary refill time is delayed (>3 seconds). Radial and ulnar pulses are diminished or absent distal to the fistula. Muscle atrophy or trophic skin changes may be present in chronic cases.
Treatment Protocol
Management options include access flow reduction (banding or revision), DRIL (Distal Revascularization-Interval Ligation) procedure, or proximalization of the arterial inflow. Conservative measures include optimization of systemic blood pressure and avoidance of limb compression. Surgical consultation for access revision is mandatory.