Hemodialysis Access-Induced Distal Ischemia (HAIDI)

Hemodialysis Access-Induced Distal Ischemia (HAIDI) is an uncommon but potentially devastating complication of arteriovenous (AV) access procedures. Significant HAIDI can lead to loss of limb function or even part of the limb if not recognized and treated appropriately and expeditiously. The pathophysiology of HAIDI is complex and results from the complicated interaction of limb flow physiology that is influenced by the inflow artery, out flow vein, arterial collaterals, and tissue bed. Treatment of HAIDI comprises two goals: resolve the ischemia to the distal limb and preserve a functioning AV access. Several surgical techniques have evolved to successfully treat HAIDI with these two goals in mind. A detailed anatomic and physiologic evaluation of the extremity arterial anatomy, access flow and measure of distal perfusion is critical in verifying the diagnosis of HAIDI and planning the most appropriate intervention to successfully resolve the ischemia. This chapter provides a detailed description of the pathophysiology, diagnosis, and treatment of HAIDI.