Abstract
Upper limb ischemia in patients with chronic kidney disease treated by haemodialysis is a known complication, but fortunately its progression into gangrene is not frequent. Ischemia occurs in 3.7-5% of dialysis patients, in dependence on the type of vascular access.
The main cause behind the risk of digital upper limb ischemia in dialysis patients is the presence of an arteriovenous fistula. The higher the location of arteriovenous fistula, the higher the risk of onset of ischemia.
In case of brachiocephalic and brachiobasilic fistulas, the risk for developing symptomatic ischemia is faced by 10-25% of patients, in case of radiocephalic fistula only by 1-1.8% of patients. In making the diagnosis we rely on the history of symptoms and physical examinations of both upper limbs.
The patient may describe subjective symptoms as pain, having cold fingers, cramps during and outside dialysis, altered sensation and impaired finger movement. The therapy includes radiological intervention, removal of high-flow arteriovenous fistula, its closure, and amputation.
The treatment aims to provide the patients with maximum possible multidisciplinary care and to prevent amputation. In this respect the orthopaedic examination is critical for further diagnosis and therapy of the patient at risk of upper limb impairment or for upper limb salvage.