title: Arterial insufficiency in hemodialysis access procedures: correction by "banding" technique.
abstract: Arterial insufficiency distal to an antecubital access is fortunately an infrequent but disturbing and often debilitating complication resulting in suboptimal access. During an 8 1/2-year period, 335 vascular access procedures were performed, 108 of which were antecubital brachiocephalic Gore-Tex conduits. Of these Gore-Tex conduits, 1.8% (2/108) had developed symptoms of vascular insufficiency 2 to 3 1/2 months after such access surgery. As previously published, arterial steal after the creation of an AV fistula could be corrected by the placement of an interposition Gore-Tex loop that would cure the problem and save the access. We have presented a procedure to correct a steal syndrome once a Gore-Tex conduit is already in place. Proximal banding and distal ligation with division of the cephalic vein below an end-to-side Gore-Tex loop is a simple surgical solution. It is not only curative but the procedure also maintains the existing Gore-Tex graft as a sustained avenue for access.
authors.affiliation: Department of General Surgery, Gelsinger Medical Center, Danville, Pennsylvania 17822-2111.
authors.forename: J C
authors.initials: JC
authors.lastname: West
authors.forename: D J
authors.initials: DJ
authors.lastname: Bertsch
authors.forename: S L
authors.initials: SL
authors.lastname: Peterson
authors.forename: M P
authors.initials: MP
authors.lastname: Gannon
authors.forename: G
authors.initials: G
authors.lastname: Norkus
authors.forename: R P
authors.initials: RP
authors.lastname: Latsha
authors.forename: S E
authors.initials: SE
authors.lastname: Kelley
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D013518:Surgery, Plastic