title: A modified DRIL procedure by flow reversal of an aborted distal cephalic vein for critical hand ischaemia.
abstract: Treatment of dialysis access-related hand ischaemia with preservation of the access remains an issue. We report the case of a patient presenting critical hand ischaemia 2 years after proximalisation of a distal radio-cephalic fistula with preservation of the original access. After valvulotomy, the distal cephalic vein was used as in situ bypass and directly anastomosed to the distal brachial artery, providing a direct flow to the hand. This procedure relieved the hand ischaemia without sacrificing the functioning fistula. Six months later, the fistula and bypass were still patent, showing that flow reversal of a previous fistula can be an efficient strategy to correct dialysis access-related hand ischaemia in selected cases.
authors.affiliation: Department for Cardiac, Vascular and Thoracic Surgery, University Hospital Henri Mondor, Av. Du Maréchal de Lattre de Tassigny, 51, 94010 Créteil, France. daniel_danzer@hotmail.com
authors.forename: D
authors.initials: D
authors.lastname: Danzer
authors.forename: M
authors.initials: M
authors.lastname: Czerny
authors.forename: M K
authors.initials: MK
authors.lastname: Widmer
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D006435:Renal Dialysis; D014680:Veins / Q000601:surgery*