Résumé
L’ischémie de main par hypoperfusion tissulaire distale sur le membre porteur d’une fistule artério-veineuse est une complication sérieuse qui peut conduire à des amputations de doigts, voire de main, si elle n’est pas traitée à temps. L’étude de la littérature montre que la physiopathologie de ce syndrome d’hypoperfusion distale est complexe et mal comprise à ce jour [1, 2]. On doit donc aborder le problème avec prudence et modestie. Il y a trois mécanismes isolés ou associés qui peuvent être invoqués : l’existence de lésions sur les artères du membre, le «vol » exercé par la fistule sur la vascularisation de la main, et parfois une hyperpression veineuse chronique. Devant une ischémie de main sur fistule de dialyse, la priorité absolue est toutefois la recherche et le traitement d’une lésion artérielle proximale qui serait aisément accessible à un traitement radiologique percutané.
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Turmel, L. (2012). Ischémie de main. In: Radiologie diagnostique et interventionnelle des accès artério-veineux pour hémodialyse. Collection de la Société française d’imagerie cardiaque et vasculaire. Springer, Paris. https://doi.org/10.1007/978-2-8178-0266-4_11
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DOI: https://doi.org/10.1007/978-2-8178-0266-4_11
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