Dialysis access induced limb ischemia corrected using quantitative duplex ultrasound

David Shemesh, Oded Olsha, Nicola J. Mabjeesh, Harry B. Abramowitz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Dialysis access induced limb ischemia (DAILI) is a rare complication after the creation of an arteriovenous fistula in infancy but can cause irreversible ischemic limb damage in severe cases. The incidence of DAILI is higher in bridge graft fistulas than in native fistulas. DAILI patients may be managed by surgically reducing the volume flow in the fistula. However, in the pediatric age group, such a reduction of volume flow may result in thrombosis or an inadequate flow for effective dialysis. Several methods have been described to achieve the delicate balance between essential flow in the fistula and adequate limb perfusion pressure. We have developed a new method employing preoperative duplex ultrasonography to predict quantitatively the reduction in volume flow in the fistula that will allow effective dialysis while providing adequate limb perfusion. The preoperative assessment was reproduced on the operating table using intraoperative duplex. A 3-year-old girl thus treated has had resolution of her ischemic symptoms and maintains long-term patency of her dialysis access.

Original languageEnglish
Pages (from-to)409-411
Number of pages3
JournalPediatric Nephrology
Issue number5
StatePublished - May 2001
Externally publishedYes


  • Arteriovenous fistula
  • Doppler
  • Duplex
  • Limb ischemia
  • Pediatric hemodialysis
  • Steal syndrome
  • Ultrasonography


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