Distal revascularisation with interval ligation (DRIL): an experience

The global increase of chronic renal failure has resulted in a growing number of patients on haemodialysis using arteriovenous fistulas (AVFs). By virtue of their very function, AVFs at times shunt blood away from regions distally, resulting in an ischaemic steal syndrome. Distal revascularisation w...

Full description

Saved in:
Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2009-07, Vol.91 (5), p.394-398
Main Authors: Field, M, Blackwell, J, Jaipersad, A, Wall, M, Silva, M A, Morgan, R H, Pherwani, A D
Format: Article
Language:English
Subjects:
Adult
Aged
Arm - blood supply
Arteriovenous Shunt, Surgical - adverse effects
Diabetes
Female
Fistula
Hemodialysis
Hospitals
Humans
Hypertension
Ischemia
Ischemia - etiology
Ischemia - surgery
Ligation
Male
Middle Aged
Patients
Regional Blood Flow
Renal Dialysis
Surgery
Vascular
Vascular Surgical Procedures - methods
Veins & arteries
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The global increase of chronic renal failure has resulted in a growing number of patients on haemodialysis using arteriovenous fistulas (AVFs). By virtue of their very function, AVFs at times shunt blood away from regions distally, resulting in an ischaemic steal syndrome. Distal revascularisation with interval ligation (DRIL) has been described as a procedure to treat symptomatic ischaemic steal. We present our experience in the management of this complication. Six patients with severe ischaemic steal were treated using a DRIL procedure between May 2004 and June 2007. There were three males and three females, all with elbow brachiocephalic AVFs. Symptoms ranged from severe rest pain to digital gangrene. Published results from international studies of 135 DRIL procedures were also reviewed. Vascular access was maintained along with the elimination of ischaemic symptoms in the six patients using an ipsilateral reversed basilic vein graft. Interval ligation of the distal brachial artery was performed at the same time. All patients showed immediate and sustained clinical improvement of symptoms with a demonstrable increase in digital pulse oximetry. DRIL is a beneficial treatment option that has proven successful at alleviating ischemic steal symptoms and preserving vascular access. This avoids placement of central lines, its associated risks, and the need to create an alternative sited fistula.
ISSN:0035-8843
1478-7083
DOI:10.1308/003588409X392153