Steal and Palmar Arch Study v3.1
Research type
Research Study
Full title
Does the absence of complete collateral pathways in the hand, as determined indirectly by Duplex ultrasound, increase the likelihood of haemodialysis access-induced distal ischemia (HAIDI) symptoms?
IRAS ID
271815
Contact name
Kate Harvey
Contact email
Sponsor organisation
Gloucestershire Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 6 months, 14 days
Research summary
Patients with severe kidney disease need to have their blood filtered by dialysis to survive. To provide high blood flow for filtering, many patients have an artery and vein surgically joined in their arm, known as a fistula. However, this leads to some blood being redirected without reaching the hand, starving it of blood. Reduced blood supply to the hand can result in mild symptoms (numbness) or severe symptoms (gangrene). If symptoms are severe, the artery and vein may need to be separated to restore blood flow to the hand. But this prevents a patient safely having life-saving dialysis.
Blood flow into the hand is provided by two main arteries in the forearm. These may either join by an arch in the hand or remain separate. If they join in the hand, there are two routes for blood flow to reach the complete hand. If one route is used by the fistula, blood can still reach the entire hand by taking the other route. Patients with arteries that do not join in the hand will not have a second route for blood flow into the hand. These patients may be more likely to experience severe symptoms and to have complications.
The blood flow in the hands of dialysis patients will be assessed with ultrasound to determine whether the two arteries in the arm join in the hand. Secondly, we will repeat this with their other hand. They will then be asked about their symptoms, showing how they relate to the arteries in their hand.
If patients without an arch are more likely to have severe symptoms, it might be better to use their other arm for a fistula if it has two arteries that join in the hand. This would reduce the risk of a patient developing life threatening problems.
REC name
West Midlands - Black Country Research Ethics Committee
REC reference
19/WM/0298
Date of REC Opinion
10 Jan 2020
REC opinion
Further Information Favourable Opinion