Intervention for access-induced ischemia: which option is the best?
BACKGROUND
Access-induced ischemia is a rare but important surgical complication with potentially devastating long-term results. The question remains which therapeutic option is the best for the different forms of ischemia.


METHODS
A review of the literature concerning access-induced ischemia (classification, treatment) was performed; furthermore, our own experience of more than 300 cases with ischemia was discussed.


RESULTS
There are four different stages of dialysis access-induced ischemia syndrome (DAIIS) that need adequate treatment: stage I conservatively, stage II fistula banding, stage III proximalization operation or distal revascularization interval ligation and stage IV closure of the access.


CONCLUSIONS
According to the many publications and to our own experience, there are good therapeutic options for many of the patients with DAIIS. However, in case of extended lesions/gangrene, closure of the access should be discussed in time before major amputation becomes necessary.
Department of Vascular Surgery, University teaching Hospital Carl von Basedow Merseburg, Merseburg - Germany.
Florian
F
Thermann
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D057510:Endovascular Procedures; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006435:Renal Dialysis; D012086:Reoperation; D016896:Treatment Outcome