Approach to Cyanotic Digits and Hand Paresis

Hand pain and nerve injury associated with an arteriovenous dialysis access are serious complications. These conditions can cause significant pain and weakness resulting in loss of optimal hand function. Advance cases may also lead to necrosis of fingers. While stealing of blood into the low-resistance arteriovenous access is generally considered to be the cause, recent information has emphasized that arterial stenosis and vascular calcification also make a significant contribution. In addition to ischemic pain, nerve injury can follow soon after the creation of an arteriovenous fistula. The so-called ischemic monomelic neuropathy can have devastating consequences for the patient. Treatment of hand ischemia should start with a detailed history and physical examination to help rule out other (non-ischemic) causes of hand pain. The choice of treatment modality and procedure to apply should be based upon appropriate evaluation. This chapter presents the strategies to combat hand ischemia and ischemic monomelic neuropathy.