Resultados del tratamiento con revascularización distal y ligadura intermedia, de la isquemia de mano después de acceso vascular para hemodiálisis

Abstract

Distal revascularization-interval ligation for ischemic steal syndrome after hemodialysis access. Experience in 23 patients Background: The creation of vascular accesses for hemodialysis can cause distal ischemia and steal syndromes. Aim: To assess the effectiveness of the technique of distal revascularization-interval ligation to alleviate distal ischemia and preserve vascular access. Material and Methods: Retrospective review of medical records, identifying 23 patients (13 women, aged between 24 and 79 years), with distal ischemia secondary to a vascular access for hemodialysis, that were treated with distal revascularization-interval ligation. Patient characteristics and outcome of the surgical procedure were recorded. Results: Fourteen patients were diabetic and 15 had high blood pressure. All had the vascular access in the elbow, 20 were done with vein and three were prosthetic. Steal appeared in a lapse ranging from hours to six years after performing the procedure. In 14 patients it appeared before 12 months. Revascularization was performed between 1 day and three months after the appearance of the steal syndrome. Seventeen patients (74%) had a substantial relief of ischemic symptoms, with healing of ulcers and digital amputations. Three patients died soon after the procedure (13%). In two the pain persisted, requiring a banding of the access, that fi nally became thrombosed. One patient required a distal forearm amputation. Thirteen patients (56%) had a late death after the procedure. After revascularization, the vascular accesses were used for a mean of two years. Conclusions: Revascularizationinterval ligation relieves distal ischemia and maintains the patency of the vascular access for hemodialysis. Patients with steal syndrome secondary to vascular access are of high risk.