Animesh Rathore

SS06. Efficacy of Surgical Correction of Dialysis Access Steal Syndrome

reduced preoperative amplitude in median motor nerves. The diabetic and HD effects are depicted in Fig 1. Decreased amplitude, CV, and increased F-latency of the median and ulnar motor nerves were linearly associated with worsening grip strength and peg board measurements, as shown in Fig 2. Whereas Disabilities of the Arm, Shoulder, and Hand score changes did not consistently correlate with significant linear changes in NCS, the trend of increased subjective dysfunction and decreased nerve function was frequently observed. These signatures were most robust in the median and ulnar motor distributions. Hand dominance and AVF configuration did not significantly influence change in neurophysiologic or biomechanical outcomes. Conclusions: This is the first description of the temporal changes in neurologic, biomechanical, and patient-perceived hand outcomes after AVF placement. Diabetes and dialysis status at time of access placement have significant effects on hand outcomes. Predictable associations between nerve parameters and objective measures of hand function are identified and provide novel insight into underlying mechanisms causing hand dysfunction after hemoaccess surgery.

The Infected Hemodialysis Access

Infection is a significant source of morbidity and mortality in the end-stage renal disease (ESRD) patients. It is the second leading cause for access loss following graft thrombosis. Likewise, infections are the second leading cause of mortality in the dialysis patients, second only to the cardiovascular mortality. The incidence of the infection is higher with the prosthetic arteriovenous grafts (AVGs) compared to autologous arteriovenous fistulae (AVF). Because of this reason, the Society for Vascular Surgery clinical practice guidelines and the KDOQI fistula first initiatives recommend the preferential use of autologous AVFs in most cases before resorting to the use of prosthetic material. This chapter discusses infection in hemodialysis access.