{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:18:22Z","timestamp":1787797102042,"version":"build-2784847793"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Haemodialysis access\u2013induced distal ischaemia (HAIDI) is an uncommon but potentially disabling complication of upper\u2010limb vascular access (VA) formation. Incidence estimates vary widely, and long\u2010term risk in New Zealand's ethnically diverse population has not previously been described. We aimed to define the incidence, natural history, risk factors, and outcomes of HAIDI in a contemporary New Zealand cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicentre cohort study included all adults undergoing upper\u2010limb VA formation between January 2020 and December 2024 at three public hospitals serving approximately 35% of New Zealand's population. Patients were identified using the Australasian Vascular Audit, with data extracted from electronic medical records. Time\u2010to\u2010event analyses and multivariable Cox regression were used to describe HAIDI risk and identify independent predictors, including ethnicity\u2010associated differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 799 patients, mean age was 55.9\u2009years, 60.3% were male, 70.5% had diabetes, 49.9% were Pacific peoples, and 24.2% were M\u0101ori. Over a median follow\u2010up of 3.0\u2009years, 46 patients developed HAIDI, corresponding to a five\u2010year cumulative risk of 6.6%. Events most commonly occurred months after access formation and continued to accrue over time. Independent risk factors were diabetes, peripheral arterial disease, and upper\u2010arm VA configuration. M\u0101ori ethnicity was associated with HAIDI in initial adjusted analyses, but this was attenuated after adjustment for measured comorbidity and access\u2010related factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this Aotearoa New Zealand cohort with high M\u0101ori and Pacific representation, HAIDI occurred in approximately one in fifteen patients and frequently required intervention. These findings support integrating comorbidity assessment into VA selection, distal\u2010first planning where feasible, and long\u2010term education and surveillance for delayed HAIDI symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70931","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:53:05Z","timestamp":1787795585000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Haemodialysis Access\u2010Induced Distal Ischaemia After Upper Limb Arteriovenous Access Formation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9290-2703","authenticated-orcid":false,"given":"Maximilian","family":"Joret","sequence":"first","affiliation":[{"name":"Department of Surgery Middlemore Hospital  Auckland New Zealand"},{"name":"Auckland Regional Vascular Service Auckland City Hospital  Auckland New Zealand"},{"name":"Department of Surgery The University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meg","family":"Beaumont","sequence":"additional","affiliation":[{"name":"Auckland Regional Vascular Service Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Whearty","sequence":"additional","affiliation":[{"name":"Auckland Regional Vascular Service Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MotoHaru","family":"Yasutomi","sequence":"additional","affiliation":[{"name":"Department of Surgery Middlemore Hospital  Auckland New Zealand"},{"name":"Auckland Regional Vascular Service Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1170-2158","authenticated-orcid":false,"given":"Uma","family":"Sreedhar","sequence":"additional","affiliation":[{"name":"Auckland Regional Vascular Service Auckland City Hospital  Auckland New Zealand"},{"name":"Department of Surgery Waikato Hospital  Hamilton New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Morris","sequence":"additional","affiliation":[{"name":"Auckland Regional Vascular Service Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Department of Surgery Middlemore Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Dean","sequence":"additional","affiliation":[{"name":"Auckland Regional Vascular Service Auckland City Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"T.Sun C.Davies E.Au et\u00a0al. 47th Report Chapter\u00a09: Kidney Failure in Aotearoa New Zealand. Adelaide Australia(2024)."},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","unstructured":"J.Schmidli M. K.Widmer C.Basile et\u00a0al. Editor's Choice\u2014Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)(2018) https:\/\/doi.org\/10.1016\/j.ejvs.2018.02.001.","DOI":"10.1016\/j.ejvs.2018.06.005"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/J.AJKD.2019.12.001"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1129729819894774"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1129729820943464"},{"key":"e_1_2_12_7_1","unstructured":"ANZDATA 42nd Annual Report 2019 (Data to 2018)|ANZORRG accessed 14 June 2026 https:\/\/anzorrg.org.au\/reports\/anzdata\u201042nd\u2010annual\u2010report\u20102019."},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.SEMNEPHROL.2019.03.001"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_12_10_1","unstructured":"National Ethics Advisory Committee Ethical Guidelines for Observational Studies: Observational research audits and related activities. 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