Strategies for predicting and treating access induced ischemic steal syndrome.
Access induced ischemia is an uncommon but devastating complication for patients maintained on hemodialysis. A number of clinical risk factors have been identified to select patients at risk. Intraoperative measurement of the digital-brachial index may further distinguish at-risk patients when the DBI is <0.45. Once clinically significant steal has developed, surgical strategies to treat this problem should ideally reverse the ischemia while maintaining uninterrupted access for hemodialysis. To date, the distal revascularization-interval ligation or DRIL procedure has been the most consistently successful tactic in achieving these dual objectives. A number of alternative strategies have recently been proposed and will be discussed.
The Southern Arizona Vascular Institute, Tucson, AZ 85704, USA.
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GS
Tynan-Cuisinier
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SS
Berman
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001916:Brachial Artery / Q000503:physiopathology; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007432:Intraoperative Period; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008026:Ligation; D011138:Polytetrafluoroethylene; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000009:adverse effects*; D018608:Ultrasonography, Doppler; D014654:Vascular Patency
D011138:Polytetrafluoroethylene