Gangrene of the Hand Following a Haemodialysis Access: Lessons to be Learnt

Renal replacement therapy is a "way of life" for patients with chronic kidney disease (CKD), and haemodialysis forms their "lifeline". Haemodialysis access, via a small surgery, to anastomose an artery and a vein in the arm or forearm, is the universally accepted standard of care. However, even this minor surgical intervention can lead to devastating complications without adequate pre-operative evaluation and apt intra-operative decision making. The following article pictorically exemplifies the most dreaded complication of a gangrenous hand as well as highlights the lessons to be learnt, in order to avoid this infirmity.

Outcome of Kidney Allografts in Recipients With a Femoral Arteriovenous Fistula: Report of Two Cases

Two patients, who were on hemodialysis over a femoral arteriovenous fistula, were transplanted in our center. Despite adequate blood pressure, perfusion of the renal allograft remained poor after completion of the vascular anastomoses. Ligation of the femoral arteriovenous fistula (1.6 L/min) led to adequate perfusion. Initial graft function was good. Although it remains unclear whether ischemia of a renal allograft is caused by venous hypertension or vascular steal due to a femoral arteriovenous fistula, it might be necessary to ligate a femoral arteriovenous fistula to obtain adequate graft perfusion.