472-93 | Potential Utility of Hand Acceleration Time in Quantifying the Degree of Malperfusion in Patients with Suspected Hemodialysis Access-Induced Digital Ischemia-JVU 472-93

JVU 472-93

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The article discusses the potential utility of hand acceleration time (HAT) as a tool to assess perfusion in patients with hemodialysis access-induced distal ischemia (HAIDI). HAIDI refers to inadequate perfusion of the hand following the placement of an upper extremity arteriovenous fistula or graft for dialysis access. The article presents a case series of four patients who presented with pain and tissue loss in the hand due to HAIDI. <br /><br />The authors used duplex ultrasound to measure HAT in the deep palmar arch to assess hand perfusion. They hypothesized that a HAT value of less than 100 ms is associated with normal hand perfusion. Based on their findings, they performed interventions such as banding of the proximal fistula or proximalization of the fistula to improve HAT and achieve resolution of symptoms.<br /><br />The authors highlight that HAIDI is primarily a clinical diagnosis, but in certain cases, it can be challenging to confirm the contribution of the fistula to the vascular issue. In these cases, HAT measurement can be a useful adjunct to support the diagnosis and predict the success of interventions. However, further research is needed to determine specific HAT thresholds and compare HAT with other measures such as finger pressures and plethysmographic waveforms.<br /><br />The article concludes that HAT measurement may be a valuable tool in assessing and managing HAIDI, but more extensive studies are required to establish its general applicability.

Keywords

hand acceleration time

HAT

perfusion assessment

hemodialysis access-induced distal ischemia

HAIDI

duplex ultrasound

deep palmar arch

interventions

proximal fistula

hand perfusion