Surgical techniques for haemodialysis access-induced distal ischaemia.
OBJECTIVE
Haemodialysis access-induced distal ischaemia (HAIDI) is a significant complication of vascular access creation, and has traditionally been difficult to manage without loss of access. Current treatment options include ligation, banding, distal revascularisation with interval ligation (DRIL), proximalisation of the arterial inflow (PAI) and revision using distal flow (RUDI). The purpose of this review was to evaluate the effectiveness of the different surgical techniques in the treatment of HAIDI.


METHODS
Electronic databases were searched for studies assessing surgical techniques in the treatment of HAIDI in accordance with PRISMA. The primary outcome for the study was symptomatic relief for each technique, defined within each study. Secondary outcomes included comparison of early thrombosis rates following each different procedure.


RESULTS
Following strict inclusion/exclusion criteria by two reviewers, twenty-seven studies of surgical interventions were included and divided into subgroups for banding, DRIL, PAI and RUDI procedures. Both DRIL and banding procedures were found to have high rates of symptomatic relief. In addition, the DRIL has a significantly lower rate of early thrombosis than banding although the more recent papers seem to suggest that early thrombosis is less of a problem in banding. PAI and RUDI showed some promise but there were too few studies to be able to make any clear conclusions.


CONCLUSIONS
All four procedures have high success rate in relieving ischaemic symptoms with the DRIL procedure having a significantly better vascular access patency rate than other techniques, although further well designed studies are required to compare all four surgical techniques.
Department of Renal Surgery, University Hospital Birmingham, Birmingham - UK.|ReDVA Research Consortium, Dundee - UK.
Julien
J
Al Shakarchi
Department of Vascular Access Surgery, Clinique Jouvenet, Paris - France.
Jan
J
Stolba
ReDVA Research Consortium, Dundee - UK.|Medical Research Institute, University of Dundee, Dundee - UK.
J Graeme
JG
Houston
Department of Renal Surgery, University Hospital Birmingham, Birmingham - UK.|ReDVA Research Consortium, Dundee - UK.
Nicholas
N
Inston
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008026:Ligation; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency