Hand Dysfunction Following Arteriovenous Access Creation

Hand dysfunction following arteriovenous access creation can be attributed to multiple etiologies including hemodialysis access-induced distal ischemia (HAIDI; ‘steal’), ischemic monomelic neuropathy, nerve injury or compression or carpal tunnel syndrome. While hand perfusion is reduced in the majority of patients with upper extremity access, especially those with brachial artery-based fistulas or grafts, <5% have clinically significant ischemia requiring intervention. In addition, ischemia alone does not always explain access-related hand dysfunction and other causes should be considered. Patients may also have subjective decrease in the perception of their limb function following access placement even in the absence of significant objective findings.