Hand ischemia

Gouny P, Gaitz JP, Vayssairat M. Acute hand ischemia secondary to intraarterial buprenorphine injection treatment with iloprost and dextran-40—a case report. Angiology 1999 50(7) 605-6. 

The authors pointed out that inadvertent intra-arterial administration of promethazine leads to ischemia and tissue necrosis. They further suggested that hand surgeons must be aware of this compUcation and consider the diagnosis of intra-arterial promethazine administration when evaluating patients with digital and hand ischemia who have recently had intravenous injection of medications. 

Vascular Access-Induced Hand Ischemia Risks and Safe Management... 

Patients with the presence or high risk of hand ischemia... 

Fig. 4. Cubital AVF in extension technique to avoid hand ischemia in patients with critically diseased arteries.

Hand ischemia is a severe adverse event in vascular access (VA) surgery that has an incidence of 1-10% [1-29]. Symptoms are usually mild with extremity coolness and vague neurosensory changes and, in most cases, resolve within a few weeks and clinical presentation can be classified into 4 stages [1]. 

Fig.1. Treatment strategy of hand ischemia at the wrist - performing a distal radial artery ligation. 

Treatment of Hand Ischemia at the Elbow in Patients with Normal VA Flow... 

A variety of techniques, such as the bandings, RUDI and PAVA or PAI, are available to treat hand ischemia in patients with normal or high VA flow. As a matter of fact, most patients in our experience and in the literature do not have... 

Gupta et al. [ 16] also reported 62% of thromboses among 22 bandings in a series including other procedures to treat hand ischemia such as DRIL, PAVA and RUDI. Among the 11 reinterventions, 8 (73%) were needed in patients with banding. 

Aimaq R, Katz SG Using distal revasculariza- 11 tion with interval ligation as primary treatment of hand ischemia after dialysis access creation. J Vase Surg 2013 57 1073-1078. 

Critical hand ischemia after angioaccess siu -gery diagnosis and treatment. Ann Vase Surg 2000 14 583-593. 13... 

Sessa C, Riehl G, Porcu P, et al Treatment of hand ischemia following angio-access surgery using the distal revascularization interval-ligation technique with preservation of vascular access description of an 18-case series. 14 Ann Vase Surg 2004 18 685-694. 

Check for hand ischemia (cold fingers, pain) and palpable pulses... 

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