Proximalization of the arterial inflow (PAI) in patients with dialysis access-induced ischemic syndrome: first report on long-term clinical results.
OBJECTIVE
Proximalization of the arterial inflow (PAI) is a promising technique which was introduced several years ago as a treatment option for patients with dialysis access-induced ischemic syndrome (DAIIS). In our institutions we have been performing PAI since 2003 and have seen positive clinical results. The aim of this prospective survey is to present the long-term results of PAI.


METHODS
Between 2003 and 2008, forty PAI operations were performed in our institutions: 4 patients had acute pain and sensorimotor dysfunction with no lesions, 33 had small acral lesions, and 3 had extended lesions following the creation of autogenous fistulas. In 22 cases a heparinized graft was used and in 18 cases a regular PTFE-graft. Criteria for successful treeatment of the disease course were evaluated by clinical and ultrasound examinations.


RESULTS
In 36 cases (90%), PAI led to clinical success which was permanent in 33 patients (82%) seen in the follow-up period of 9 to 40 months. Primary patency was 62% after 12 months and secondary patency was 75% after 18 months. Heparinized grafts led to better patency rates. In 3 out of the 4 patients with large acral lesions, graft explantation was necessary due to infection or failing success.


CONCLUSIONS
Based on our experience, clinical long-term results are successful in certain patients with DAIIS. The aim for the near future should be a better patency rate to minimize the need for reoperations. In cases of extended limb necrosis/gangrene results were poor. In such patients primary closure of the access must be discussed.
Department of Vascular Surgery, St. Elisabeth and St. Barbara University Teaching Hospital, Halle, Germany. florian.thermann@medizin.uni-halle.de
Florian
F
Thermann
Ulrich
U
Wollert
Jörg
J
Ukkat
Henning
H
Dralle
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D020099:Coated Materials, Biocompatible; D005858:Germany; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015993:Life Tables; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D011474:Prosthesis Design; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency
D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D006493:Heparin