Proximalization of the Arterial Inflow (PAI) in Patients with Dialysis Access-Induced Ischemic Syndrome: First Report on Long-Term Clinical Results

Abstract

Based on our experience, clinical long-term results are successful in certain patients with DAIIS. The aim for the near future should be a better patency rate to minimize the need for reoperations. In cases of extended limb necrosis/gangrene results were poor. In such patients primary closure of the access must be discussed.

A Modified Approach of Proximalization of Arterial Inflow Technique for Hand Ischemia in Patients with Matured Basilic and Cephalic Veins

“…The success rate (complete regression of symptoms) was 84% and only mild rest symptoms in 13% of patients were reported. These excellent results were also confirmed in a study published by Thermann et al 13 They reported an 82% success rate in 40 patients. These data demonstrate nearly identical rates of symptom relief to the well-known results of the DRIL procedure.…”

“…A subgroup analysis revealed the inferior performance of non-heparinized versus heparinized grafts, with 31% versus 75%, respectively, after 12 months. 13 The functional patency of the modified PAI fistulas was similar to that of Zanow. However, KaplaneMeier analysis of a small cohort cannot be used.…”

“…Some published studies report infection rates of up to 20% for AVGs compared with about 5% for AV fistulae. 16e18 Zanow reported about 1/30 (3%) 6 and Thermann about 3/40 (7.5%; 1 graft infection and 2 perigraft reaction) 13 infected grafts. Although the published graft infection rates in both PAI studies were very low, these results could be the consequence of the very great experience of both vascular access centers.…”

“…There have only been two publications on the PAI technique with mid-to long-term follow-up. 6,13 Zanow et al 6 reported 30 patients treated with PAI. The success rate (complete regression of symptoms) was 84% and only mild rest symptoms in 13% of patients were reported.…”

Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER): A Review of the Available Literature and Brief Overview of Alternate Therapies in Dialysis Associated Steal Syndrome

“…In two further studies by Thermann et al, PAI was reviewed in 23 and 36 patients respectively [ 18 , 19 ]. In their early series, complete resolution of symptoms was achieved in 65% of patients and improvement seen in 26% with secondary patency of 85% at 18 months.…”