Flow Interruption of the Distal Radial Artery: Treatment for Finger Ischemia in a Matured Radiocephalic AVF

Abstract

Diagnosis using physical examination, angiography and treatment with embolization or ligation of the DRA can be performed with great success in an outpatient setting.

Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas for hemodialysis

“…Indeed, radial artery ligation was performed in all patients for AVF access in its original description by Röhl at al, 2 resulting in the exact hemodynamic configuration of RADAR. Ligation and radial artery transposition are mainly performed to reduce high flow (>1500 mL/min) and steal syndrome, even in pediatric patients, [29][30][31] and are safe in the presence of a patent ulnar artery and a palmar arch free from major calcification. These criteria were retained as prerequisites for RADAR.…”

Extensor pollicis longus tendon compression as the etiology of a true aneurysm of the radial artery in the anatomical snuff box

“…In most individuals, the ulnar artery is the larger branch of the brachial artery and is the dominant artery supplying the hand through the superficial palmar arch. 10 Radial artery ligation is usually well tolerated, as typified in trauma, 11 distal radial artery ligation for steal syndrome, 12 and radial artery harvest for bypass. 13,14 However, spontaneous or traumatic radial artery thrombosis with acute thumb and finger ischemia has been described with morbid outcomes.…”

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…182 For RCAVFs an end to end anastomosis has been advised by some to prevent steal syndrome 183 but the incidence of steal in distal AVFs is very low and in the rare occasions where it does occur it can easily be treated by ligation of the distal radial artery under local anaesthetic provided that the ulnar artery is patent. 184,185 Moreover, the radial artery usually remains patent after thrombosis of the VA and provides the blood supply to the hand.…”

“…7c). 184,185,592,596 VA induced ischaemia with normal or near normal VA flow and significant distal vascular disease represent the majority of cases. 263 Several reports support the use of a DRIL procedure.…”