Lower Extremity Ischemia After Femoral Arteriovenous Bovine Shunts

Abstract

Use of bovine carotid artery grafts for femoral arteriovenous fistulas is now an accepted method of circulatory access for patients who require chronic hemodialysis. A serious but infrequently mentioned complication of this technique is lower extremity ischemia secondary to an arterial steal phenomenon. Three cases of this syndrome are presented and specific recommendations made for preoperative and intraoperative evaluation in order to avoid this complication. A possible surgical technique for correction of this syndrome is also discussed.

Modified Banding of Arteriovenous Fistulas for the Treatment of Vascular Access Induced Digital Ischaemia

“…Several treatment options have been described previously. Dialysis access AVF banding was first described in the 1970s, 8 and the technical aspects of this procedure continue to improve. Based on the literature, banding has been associated with increased loss of access and more complications relative to other methods used to treat VA induced ischaemia.…”

“… 5 Thirty day complication rates of ligation, DRIL, revision using distal inflow, PAI, and distal radial artery ligation were 8.2%, 7.1%, 37%, 44%, and 0%, respectively. 5 Several technical methods for banding have been described, including, but not limited to, the minimally invasive limited ligation endoluminal assisted revision (MILLER) technique, 9 T banding, 10 use of intra-operative flow monitoring, 3 , 8 and photoplethysmography. 6 Various clinical success rates have been described with these procedures, ranging from 89% with the MILLER technique to 72% with T banding.…”

Latero-lateral femoro-femoral arteriovenous fistula: a new surgical approach for hemodialysis patients with no vascular access

“…Jackson and colleagues 6 reported that the superficial femoral vein is an ideal material for vascular access in the lower extremities. However, complications are frequent including thromboses, cardiac failure, symptomatic distal leg ischemia (steal syndrome), aneurysm, edema of the limb and infection 14,15 . Despite of having reported low incidence of CVI, steal syndrome is a major concern as well.…”

Arteriovenous fistula construction in the thigh with transposed superficial femoral vein: Our initial experience

“…16 The incidence of distal ischemia after arteriovenous bridge graft construction in the lower extremities is markedly higher than in the upper extremities and is usually attributed to the higher prevalence of arteriosclerotic occlusive disease in the lower extremities. 11,17 In a study of 45 patients who had lower extremity bridge grafts and No tSFV or composite PTFE-tSFV fistula became infected during the study period. One patient had total occlusion of the ipsilateral iliac vein 8 months after fistula construction.…”