Surgical Banding for Refractory Hemodialysis Access-Induced Distal Ischemia (HAIDI)

Abstract

Hemodialysis patients may develop distal ischemia in an extremity harboring a functioning arteriovenous access (AVA). Surgery is indicated if conservative treatment including catheter-based therapies fails. The role of surgical banding for refractory hemodialysis access-induced distal ischemia (HAIDI) is systematically reviewed (n=39 articles). If banding is executed without an intraoperative monitoring tool ("blind"), or guided by finger pressures only, clinical success and access patency rates are low (<50%). In contrast, banding is clinically successful when access flow is monitored during the operative procedure, with excellent long-term patency of banded AVA's (97%, 17 +/- 3 months). Banding is the method of choice in HAIDI patients with a normal or high access flow (>1.2 l/min) provided that flow and distal perfusion are closely monitored intraoperatively.

Side Branch Ligation for Haemodialysis-access-induced Distal Ischaemia

“…The effect of any invasive procedure on finger perfusion should be monitored intraoperatively using plethysmography while ideally simultaneously measuring access flow. 11,25 The goal is to attain an increase in finger pressures while sufficient access flow for adequate haemodialysis is maintained. Another possible issue is the safety of a corrective AVF procedure.…”

Dilator‐Assisted Banding for Managing Complications Associated with Excessive Hemodialysis Access Flow

“…Flow reduction procedures • Dilator-assisted banding (DAB) Simple, economical, fluoroscopy optional • Balloon-assisted banding (MILLER) (7) Minimally invasive, fluoroscopy required • Plication (6,25) Simple, effective, unguided • Unguided surgical banding (4,9,10) Low success and high thrombosis rates • Flow-guided banding or tapering (1) Better outcome than unguided banding • Hemo-Clip banding (3) Simple, needs flow guidance • T-Banding (11) Effective, more complex procedure Rerouting of arterial flow…”

Utility of perioperative skin perfusion pressure measurement for treatment of ulcers caused by arteriovenous access ischaemic steal

“…Although adequate distribution of blood flow towards both the fistula and the distal extremity are required, the optimal degree of vascular lumen reduction to accomplish this has not been defined. To achieve an optimum balance while addressing AVAIS surgically, several intraoperative monitoring methods have been described, such as pulse oximetry, photoplethysmography, electromagnetic flow metre, and Doppler ultrasound . Ideally, intraoperative monitoring tools should help determine the appropriate degree of flow reduction and lead to better results compared with procedures performed without monitoring .…”