Relationship of hemodialysis access to finger gangrene in patients with end-stage renal disease

Richard A. Yeager, Gregory (Greg) Moneta, James Edwards, Gregory Landry, Lloyd M. Taylor, Donald McConnell, John M. Porter

Research output: Contribution to journalArticle

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Abstract

Objective: We report a comprehensive review of our patients on hemodialysis with end-stage renal disease (ESRD) with finger gangrene to determine etiology, natural history, and prognosis of this condition. Methods: Patients with ESRD with finger gangrene were identified from our computerized vascular registry. Presence of an ipsilateral arteriovenous fistula was determined, and patients were compared with a group of patients with ESRD without finger gangrene. Management consisted of arteriography, selective arteriovenous fistula management, and finger amputation. A multivariate analysis to determine risk factors associated with finger gangrene was performed. Repeat finger amputation and survival rates were determined with life-table analysis. Results: Twenty-three patients (mean age at start of dialysis, 53 years) with finger gangrene were identified, with 48% (n = 11) having a functional ipsilateral arteriovenous fistula. Arteriography was consistent with diffuse atherosclerosis involving the radial, ulnar, palmar, and digital arteries precluding attempts at distal arterial bypass. Repeat finger amputations were necessitated in 52% of patients (n = 12), and bilateral finger gangrene developed in 61% of patients (n = 14). Starting dialysis at age less than 55 years (P = .0004), diabetes (P = .001), coronary artery disease (P = .0212), and lower extremity arterial occlusive disease (P <.0001) were significantly associated with finger gangrene. Conclusion: The young diabetic patient with diffuse vascular disease and ESRD is at high risk for the development of finger gangrene on chronic hemodialysis. Finger gangrene is the result of distal atherosclerosis and is not primarily related to dialysis access.

Original languageEnglish (US)
Pages (from-to)245-249
Number of pages5
JournalJournal of Vascular Surgery
Volume36
Issue number2
DOIs
StatePublished - Aug 2002

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Gangrene
Fingers
Chronic Kidney Failure
Renal Dialysis
Arteriovenous Fistula
Amputation
Dialysis
Atherosclerosis
Angiography
Arterial Occlusive Diseases
Life Tables
Natural History
Vascular Diseases
Blood Vessels
Registries
Coronary Artery Disease
Lower Extremity
Multivariate Analysis
Survival Rate
Arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Relationship of hemodialysis access to finger gangrene in patients with end-stage renal disease. / Yeager, Richard A.; Moneta, Gregory (Greg); Edwards, James; Landry, Gregory; Taylor, Lloyd M.; McConnell, Donald; Porter, John M.

In: Journal of Vascular Surgery, Vol. 36, No. 2, 08.2002, p. 245-249.

Research output: Contribution to journalArticle

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