Distal revascularization–interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome

Berman, Scott S.; Gentile, Andrew T.; Glickman, Marc H.; Mills, Joseph L.; Hurwitz, Richard L.; Westerband, Alex; Marek, John; Hunter, Glenn C.; McEnroe, C. Scott; Fogle, Martin A.; Stokes, Gordon K.

doi:10.1016/s0741-5214(97)70032-6

Cited by 202 publications

(154 citation statements)

References 19 publications

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“…[12][13][14][15][16] Schanzer later published a series of 14 cases in 1992 and 23 cases in 1996. In the last series, all 23 patients showed clinical improvement of their dialysis-associated ischemic symptoms and demonstrated a 95.6% patency at 2 years.…”

Section: The Dril Proceduresmentioning

confidence: 99%

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Regalado

Navuluri²,

Vikingstad³

2009

Semin intervent Radiol

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Dialysis-associated steal syndrome is a clinically significant complication associated with the creation of dialysis grafts or fistulae. The distal revascularization and interval ligation (DRIL) procedure is a surgical procedure, which has been used to treat patients with hand ischemia secondary to arterial ''steal'' from dialysis accesses. This article will review the dialysis-associated steal syndrome and the history, anatomy, and clinical results of the DRIL procedure.

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Section: The Dril Proceduresmentioning

confidence: 99%

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Regalado

Navuluri²,

Vikingstad³

2009

Semin intervent Radiol

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“…Since providing access for haemodialysis is a priority, the performance of the fi stula in the elbow is preferred in diabetic patients to the radiocephalic forearm fi stula, which is patent yet unsuitable for cannulation 17 . The actual occurrence of the steal syndrome demonstrations after elbow fistula performance between the brachial artery and the cephalic or basilic veins is diffi cult to assess because published reports usually do not specify the performance type with regard to fi stula complications 14,32,33 . The steal syndrome fi stula has an asymptomatic form, the so-called "physiological steal" which occurs in 80 % of the patients, and a symptomatic form.…”

Section: Resultsmentioning

confidence: 99%

“…Eff ort should mainly be made to recognise the early manifestations in order to treat the fi stula in time. A number of methods are recommended: physical examination of the site 24 , digital plethysmography of the arm periphery 24,25,33 , skin temperature monitoring 24 , periphery oxygenation measurement 24 , digital pressure measurements 37 , vessel bundle fl ow rate assessment by colour duplex sonography 33 or arteriography of the entire fi stula bed with or without fi stula compression 25,33 . The fi stula fl ow rate, however, does not typically infl uence steal development.…”

Section: Resultsmentioning

confidence: 99%

“…The method was described by Schanzer 39 and applied by other authors who describe positive results, i.e. the ischemic symptoms improved in 90-100 % while maintaining fi stula patency in 80-100 % 22,25,33 . In patients with a poor arterial bed in the elbow, the anastomosis on radial or ulnar artery may be technically impossible.…”

Section: Autogenous Arteriovenous Elbow Fi Stula For Haemodialysis Anmentioning

confidence: 99%

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Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Bachleda¹,

Utíkal²,

Kojecký³

et al. 2007

BIOMED PAP

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Background:The autogenous brachiocefalic or brachiobasilic arteriovenous elbow fi stula is not considered to be only the secondary haemodialysis access. In patients with an unsuitable forearm vessel bundle, it is indicated as primary access and it is the method preferred to the fi stula creation using a vascular prosthesis. Its rather rare complication is the development of upper extremity ischemia.Aim: To summarise current knowledge of this fi stula type and its associated complications Methods: Review of the literature. Results:The creation and maturation of the fi stula and occurrence of the steal syndrome is infl uenced by a number of factors. The analysis and awareness of such factors will provide for creation of a suitable fi stula as well as for timely complication diagnostics and treatment.Conclusions: The autogenous elbow fi stula utilising the brachial artery and the cephalic or basilic vein in the upper extremity represents a high-quality haemodialysis access. Its potential complication is the occurrence of the steal syndrome. Its occurrence and manifestations do not constitute indications for ligation of the access. The gathered information shows that a suitable surgical procedure can help meet the basic rule for haemodialysis access -resolving the ischemia and maintaining the access.

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“…Segundo Barnes 12 , a ligadura da artéria pode ser dispensada na presença de doença arterial oclusiva distal importante, pois dificultaria o fluxo retrógrado arterial, que é a principal característica do roubo sintomático.…”

Section: Figura 4 -Cicatrizaçãounclassified

Tratamento cirúrgico da "síndrome do roubo" em acesso vascular para hemodiálise com revascularização distal e ligadura arterial

Linardi

Bevilacqua

et al. 2006

J. vasc. bras.

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OBJETIVO: O propósito do trabalho é apresentar o resultado do tratamento da "síndrome do roubo", sintomática em acesso vascular para hemodiálise, utilizando a técnica da revascularização distal com ligadura arterial. PACIENTES E MÉTODOS: No período de dezembro de 2003 a novembro de 2004, quatro pacientes que apresentaram síndrome do roubo sintomática em acesso vascular para hemodiálise foram submetidos à revascularização distal com ligadura arterial e acompanhados até dezembro de 2005. Os quatro pacientes apresentavam dor de repouso, e dois casos evoluíram para lesão trófica. RESULTADOS: Todos os casos apresentaram regressão dos sintomas, com cicatrização das lesões tróficas e manutenção do acesso vascular, que continuou sendo utilizado para realização de sessões de hemodiálise. CONCLUSÕES: Concluímos que, atualmente, o tratamento de escolha da síndrome do roubo sintomática é a revascularização distal com ligadura arterial, pois, além de tratar a isquemia do membro, mantém o acesso vascular funcionante.

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Distal revascularization–interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome

Abstract: The DRIL technique reliably restores antegrade flow to the ischemic limb, eliminates the potential pathway for the steal physiologic mechanism, and maintains continuous dialysis access in these difficult patients.

Cited by 202 publications

References 19 publications

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Tratamento cirúrgico da "síndrome do roubo" em acesso vascular para hemodiálise com revascularização distal e ligadura arterial

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