Utility of TcPO2 in Assessing Microcirculatory Improvement and Minimizing Amputation Levels for Hemodialysis Access-Induced Distal Ischemia: A Case Report.

Conventional pressure-based assessments (e.g., skin perfusion pressure) of Hemodialysis Access-Induced Distal Ischemia (HAIDI) are often limited by pain or ulcer location. We report the utility of transcutaneous oxygen pressure (TcPO2) for objective clinical decision-making in this setting. An 84-year-old man developed ischemic necrosis of the left index, middle, and ring fingers secondary to HAIDI after arteriovenous graft creation. Angiography confirmed hemodynamic steal, which was treated with collateral vein coil embolization to restore perfusion while preserving access. TcPO2 improved markedly from 29 to 73 mmHg (palm) and 6 to 64 mmHg (dorsum) post-intervention. These values exceeded the 40-mmHg healing threshold typically used for lower-extremity ischemia. Supported by these objective findings and favorable clinical progression, limited amputation was successfully performed instead of major amputation, resulting in complete healing. TcPO2 provides a practical, noninvasive complementary means to confirm microcirculatory recovery, supporting decisions on the timing and feasibility of limited amputation in HAIDI when conventional methods are impractical.