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Bachmann C, Parker M, Sardana T, Ramsey L, Hashemi H. Proximalization of arterial inflow for treatment of hemodialysis access-induced distal ischemia. J Vasc Surg 2024:S0741-5214(24)01224-2. [PMID: 38909917 DOI: 10.1016/j.jvs.2024.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Hemodialysis access-induced distal ischemia (HAIDI) is a known complication of hemodialysis (HD) access. Distal revascularization and interval ligation (DRIL) is the preferred treatment for HAIDI by many surgeons. Proximalization of arterial inflow (PAI) is a promising alternative technique that, unlike DRIL, preserves the native arterial inflow. The purpose of this study is to report our experience with PAI on a series of 64 patients. METHODS This is a single-center, retrospective cohort study of patients with both arteriovenous (AV) fistulas and grafts who underwent PAI for HAIDI from 2017 to 2023. A 4 × 7 tapered polytetrafluoroethylene (PTFE) graft was used to connect HD access inflow to the axillary artery in the majority of cases. The primary outcome of the study is resolution of HAIDI (complete, partial, or no resolution). Secondary outcomes include functional patency (primary and secondary) and 30-day complications following PAI. RESULTS Of the 71 patients identified to have had PAI between May 2017 to August 2023, seven were lost to follow-up. In total, 64 patients were included, with an average age of 65 years (standard deviation, 15 years), 59.4% (38/64) female, and 37.5% (24/64) African American. The study population was notable for numerous comorbid conditions including 95.3% (61/64) hypertension; 50% (32/64) coronary artery disease; 79.7% (51/64) diabetes; and 43.8% (28/64) smoking history. Following PAI intervention for HAIDI, 55 of 64 patients (85.9%) experienced complete resolution of ischemic symptoms; five of 64 patients (7.8%) had partial resolution; two of 64 patients (3.1%) had no resolution, and two of 64 patients (3.1%) had unknown resolution. Primary patency at 1, 12, and 24 months was 94%, 81%, and 71%, respectively. Secondary patency at 1, 12, and 24 months was 97%, 87%, and 84%, respectively. The 30-day complication rate was 10.9% (7/64), with five of 64 (7.8%) thromboses, one of 64 (1.6%) thrombosis and infection, and one of 64 (1.6%) upper extremity swelling secondary to central venous stenosis (resolved with angioplasty of central venous system). Failure rate due to thrombosis at 12 and 24 months was 14% (9/64) and 15.6% (10/64), respectively. CONCLUSIONS Our study, the largest case series of PAI to date, demonstrates that PAI is a reliable option for HAIDI intervention and has comparable safety and efficacy results to DRIL, despite the use of a synthetic graft. Furthermore, PAI has the added benefit of maintaining the native arterial pathway. Further investigation of PAI is warranted as a promising alternative to DRIL for HAIDI management.
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Affiliation(s)
- Caila Bachmann
- University of Virginia School of Medicine, Charlottesville, VA.
| | - Michael Parker
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, IL
| | | | - Lolita Ramsey
- Department of Surgery, Surgery Service Line Research Team, Inova Health System, Falls Church, VA
| | - Homayoun Hashemi
- Division of Vascular Surgery, Department of Surgery, Inova Health System, Falls Church, VA
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Whitaker L, Etkin Y. The enduring success of the DRIL technique and new advances in dialysis access. J Vasc Surg Cases Innov Tech 2024; 10:101490. [PMID: 38566913 PMCID: PMC10985288 DOI: 10.1016/j.jvscit.2024.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
| | - Yana Etkin
- Northwell, New Hyde Park, NY
- Department of Surgery at Zucker School of Medicine, Manhasset, NY
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Graham A, Weaver ML, Holscher C, Reifsnyder T. Expected Duplex Ultrasound Results in Distal Revascularization and Interval Ligation Conduits. Ann Vasc Surg 2023; 97:157-162. [PMID: 37460015 DOI: 10.1016/j.avsg.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/07/2023] [Accepted: 06/17/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND There are no published standards for the expected findings on noninvasive testing following distal revascularization and interval ligation (DRIL). This study evaluated the hemodynamic results and duplex ultrasound characteristics of DRIL. METHODS A retrospective chart review of patients who underwent DRIL using autogenous vein between 2008 and 2019 was performed. Patients with both preoperative and follow-up noninvasive testing were included. RESULTS Thirty-eight patients were included in the study. Median time to first follow-up was 30 days (range 1-226 days), where 12 had complete resolution of their symptoms and 26 had partial resolution. Of the 27 patients that had preoperative and postoperative testing, the wrist brachial index improved from 0.56 to 0.90 with the median finger pressure improving from 56 to 73 (P < 0.001). Seventeen patients had a second follow-up (sFU) at a median time from DRIL of 196 days (range 106-843 days). There was no significant difference in wrist brachial index or finger pressures between first follow-up and sFU. Duplex ultrasound of the DRIL conduits (n = 32) showed a very consistent pattern with elevated median velocities proximally (inflow 235 cm/sec, proximal anastomosis 217.7 cm/sec) and distinctly slower median velocities distally (midconduit 46.4 cm/sec, distal anastomosis 78.3 cm/sec, outflow 59.3 cm/sec). The same pattern of velocities was held constant at the sFU (n = 16). CONCLUSIONS In this study, velocities at the proximal anastomosis were significantly higher than velocities more distal in the DRIL bypass without evidence of stenosis. This may be due to hemodynamic changes in the brachial artery associated with presence of a fistula. Elevated velocities at the proximal anastomosis do not necessarily warrant further evaluation or intervention without other evidence of conduit compromise.
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Affiliation(s)
- Alexis Graham
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
| | - M Libby Weaver
- Division of Vascular Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Courtenay Holscher
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA
| | - Thomas Reifsnyder
- Division of Vascular Surgery, Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD
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Gusev MV, Mannoia KA, Patel ST. Rapid progression of finger gangrene in a hemodialysis patient: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231207710. [PMID: 37904785 PMCID: PMC10613399 DOI: 10.1177/2050313x231207710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 11/01/2023] Open
Abstract
Severe hemodialysis access-induced distal ischemia is an uncommon complication after arteriovenous fistula creation. Finger amputation is rare and generally does not involve the entirety of the digit. The distal revascularization interval ligation procedure has become less commonly used for hemodialysis access-induced distal ischemia over the past decade. The procedure typically requires general anesthesia, greater saphenous vein harvest, and brachial artery ligation. We describe a 64-year-old female with hypertension, diabetes mellitus, and end-stage renal disease on hemodialysis via a well-functioning brachiocephalic arteriovenous fistula who developed rapid progression of finger gangrene. She underwent the distal revascularization interval ligation procedure, followed by finger amputations. The finger amputations healed within 6 months of the distal revascularization interval ligation procedure and the fistula was preserved at 2-year follow-up.
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Affiliation(s)
- Maksim V Gusev
- Division of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Kristyn A Mannoia
- Division of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Sheela T Patel
- Division of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA
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Stoecker JB, Li X, Clark TWI, Mantell MP, Trerotola SO, Vance AZ. Dialysis Access-Associated Steal Syndrome and Management. Cardiovasc Intervent Radiol 2023; 46:1168-1181. [PMID: 37225970 DOI: 10.1007/s00270-023-03462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
Dialysis-associated steal syndrome (DASS) occurs in 1-8% of hemodialysis patients with arteriovenous (AV) access. Major risk factors include use of the brachial artery for access creation, female sex, diabetes, and age > 60 years. DASS carries severe patient morbidity including tissue or limb loss if not recognized and managed promptly, as well as increased mortality. Diagnosis of DASS requires a directed history and physical exam supported by non-invasive testing. Prior to definitive therapy, detailed arteriography, fistulography, and flow measurements are performed to delineate underlying etiologies and guide management. To optimize success, DASS treatment should be individualized according to access location, underlying vascular disease, flow dynamics, and provider expertise. Possible causes of DASS include extremity inflow or outflow arterial occlusive disease, high AV access flow rate, and reversal of distal extremity arterial blood flow; DASS may also exist without any of the prior features. Depending on the DASS etiology, various endovascular and/or surgical interventions should be considered. Regardless, in the majority of patients presenting with DASS, access preservation can be achieved.
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Affiliation(s)
- Jordan B Stoecker
- Division of Vascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xin Li
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy W I Clark
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Penn Presbyterian Medical Center, 4 Wright Saunders Building, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Mark P Mantell
- Division of Vascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ansar Z Vance
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Penn Presbyterian Medical Center, 4 Wright Saunders Building, 51 N. 39th Street, Philadelphia, PA, 19104, USA.
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Ntina G, Mavromanolaki E, Flouris AD. Toward More Inclusive Networks and Initiatives in Innovation Ecosystems: Protocol for a Systematic Review. JMIR Res Protoc 2022; 11:e34071. [PMID: 35612890 PMCID: PMC9178449 DOI: 10.2196/34071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Expanding the cooperation and enlarging the participation of more diverse stakeholders within innovation ecosystems will increase their efficiency and capacity to contribute at local, regional, and national levels. Objective This paper presents the protocol for a systematic review that will identify “opening-up” strategies of innovation ecosystems for increasing the participation of more diverse innovation stakeholders, particularly from low-innovation countries, during the ecosystem formation period. Methods An algorithmic search in 4 databases (Web of Science, Cochrane Library, Scopus, and Social Science Research Network) will be applied based on the PerSPecTIF (perspective, setting, phenomenon of interest/problem, environment, optional comparison, time/timing, and findings) methodology, the Cochrane guidelines for qualitative evidence synthesis, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Selection criteria for eligibility include peer-reviewed articles published after December 31, 1999, and containing original data. No restrictions will be placed on the article language and study region, design, or methodology. Methodological strengths and limitations will be assessed using the Critical Appraisal Skills Programme tool. The thematic synthesis method will be adopted, and the GRADE-CERQual tool will be used to assess confidence. Results A preliminary search in Web of Science revealed 2758 records. This work is part of the ANGIE project, which was funded by the European Union’s Horizon 2020 research and innovation program (grant 952152) in January 2021. We anticipate that the results of this systematic review will be published in spring 2022. Conclusions We anticipate that the outcomes of this systematic review will outline the best practices used by initiatives and networks, as well as their impacts on creating larger and more inclusive ecosystems. Trial Registration OSF Registries osf.io/hc62k 10.17605/OSF.IO/HC62K International Registered Report Identifier (IRRID) PRR1-10.2196/34071
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Affiliation(s)
| | | | - Andreas D Flouris
- Discovery Foundation, Heraklion, Crete, Greece.,FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
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Pirozzi N, De Alexandris L, Scrivano J, Fazzari L, Malik J. Ultrasound evaluation of dialysis access-related distal ischaemia. J Vasc Access 2021; 22:84-90. [PMID: 34281414 PMCID: PMC8606801 DOI: 10.1177/1129729820932420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some.Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.
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Affiliation(s)
- N Pirozzi
- Interventional Nephrology, Nephrology and Dialysis Unit, Nuova ITOR, Rome, Italy
| | - L De Alexandris
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Nephrology Unit, Sant'Andrea Hospital, Rome, Italy
| | - J Scrivano
- Interventional Nephrology, Nephrology and Dialysis Unit, Nuova ITOR, Rome, Italy
| | - L Fazzari
- Interventional Nephrology, Nephrology and Dialysis Unit, Nuova ITOR, Rome, Italy
| | - J Malik
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Sen I, Tripathi R. Dialysis associated steal syndromes. A narrative review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:146-154. [PMID: 34235901 DOI: 10.23736/s0021-9509.21.11830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To review contemporary concepts in the genesis of Dialysis Access Steal Syndrome (DASS) and its current management. METHODS An electronic search of literature from 1960 to 2020 in Pubmed and the Cochrane library was conducted and practice guidelines were examined. Search terms included dialysis, steal, ischemia, access and ESRD. Clinical presentation, pathophysiology, risk factors, diagnostic techniques and management outcomes of extremity ischemia following dialysis access creation were reviewed. RESULTS Symptomatic steal occurs in 4-10% of patietns after creation of hemodialysis access creation. Risk factos include brachial based fistula, diabetes, female sex, coronary heart disease, cerebrovascular disease, tobacco use, age more than 60 and hypertension. Diagnosis is mainly clinical and can be aided by non invasive testing. Correction o finflow stenosis, Distal revasulatisation with interval ligation, revision using distal inflow or other techniques are useful for fistula preservation. CONCLUSIONS Dialysis associated steal syndromes have a complex haemodynamic causation. Clinical presentation is diagnostic; however when the diagnosis is uncertain adjunctive noninvasive perfusion tests, duplex and other imaging amy be required. Management is guided by anatomic, patient and disease-related considerations.
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Affiliation(s)
- Indrani Sen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA -
| | - Ramesh Tripathi
- Department of Surgery, School of Medicine, University of Queensland, Queensland, Australia
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Fitzpatrick G, Kiely P, Jeong B, Macaulay E. Does a failed DRIL mean the end for a fistula? A case report in the use of an Amplatzer plug post DRIL procedure for ongoing steal syndrome. J Vasc Access 2021; 23:813-815. [PMID: 33818181 DOI: 10.1177/11297298211006992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dialysis access steal syndrome is a well-recognised complication, affecting 1%-8% of all patients who undergo arteriovenous fistula formation particularly those that are brachial based. We present a case of ongoing steal syndrome following a DRIL procedure via retrograde flow in the ulnar artery. This was managed via a hybrid procedure and the use of an Amplatzer plug. This case demonstrates a novel use for the Amplatzer occlusion device, it is also a reminder that failure to occlude the vessel close to the fistula anastomosis can result in continued steal despite a functioning DRIL bypass.
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Affiliation(s)
- Gemma Fitzpatrick
- Vascular Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Philip Kiely
- Vascular Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Bora Jeong
- Vascular Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ewan Macaulay
- Vascular Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
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Mallios A, Bourquelot P, Franco G, Hebibi H, Fonkoua H, Allouache M, Costanzo A, de Blic R, Harika G, Boura B, Jennings WC. Midterm results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System, technical recommendations, and an algorithm for maintenance. J Vasc Surg 2020; 72:2097-2106. [DOI: 10.1016/j.jvs.2020.02.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/25/2020] [Indexed: 01/02/2023]
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Tolba M, Maresch M, Kamal D. Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula. J Surg Case Rep 2020; 2020:rjaa314. [PMID: 32963762 PMCID: PMC7490220 DOI: 10.1093/jscr/rjaa314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/27/2020] [Accepted: 07/18/2020] [Indexed: 11/23/2022] Open
Abstract
We present a case of dialysis associated steal syndrome in a hemodialysis patient with left radiocephalic arteriovenous fistula that caused him severe rest pain. Angiography showed retrograde flow from the ulnar artery to the distal radial artery through a hypertrophied palmar arch. The problem was solved by surgical ligation of the distal radial artery leading to complete relief of patient symptoms without any notable complications.
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Affiliation(s)
- Mahmoud Tolba
- Department of Surgery, Vascular Surgery Service, Bahrain Defense Forces Hospital, Royal Medical Services, Riffa, Bahrain
| | - Martin Maresch
- Department of Surgery, Vascular Surgery Service, Bahrain Defense Forces Hospital, Royal Medical Services, Riffa, Bahrain
| | - Dhafer Kamal
- Department of Surgery, Vascular Surgery Service, Bahrain Defense Forces Hospital, Royal Medical Services, Riffa, Bahrain
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Weaver ML, Holscher CM, Graham A, Reifsnyder T. Distal revascularization and interval ligation for dialysis access-related ischemia is best performed using arm vein conduit. J Vasc Surg 2020; 73:1368-1375.e1. [PMID: 32882351 DOI: 10.1016/j.jvs.2020.07.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/25/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Distal revascularization and interval ligation (DRIL) is an effective approach to the management of hemodialysis access-related ischemia that offers both symptom relief and access salvage. The great saphenous vein (GSV) has been the most commonly used conduit. However, the use of an ipsilateral arm vein will allow for performance of the operation with the patient under regional anesthesia and might result in lower harvest site morbidity than the GSV. We sought to determine the suitability of DRIL using an arm vein compared with a GSV conduit. METHODS All patients who had undergone DRIL from 2008 to 2019 were retrospectively identified in the electronic medical records. The characteristics and outcomes of those with an arm vein vs a GSV conduit were compared using the Wilcoxon log-rank and χ2 tests. Access patency was examined using Kaplan-Meier methods, with censoring at lost to follow-up or death. RESULTS A total of 66 patients who had undergone DRIL for hand ischemia were included in the present study. An arm vein conduit was used in 40 patients (median age, 65 years; 25% male) and a GSV conduit in 26 patients (median age, 58 years; 19% male). No significant differences in comorbidities were found between the two groups, with the exception of diabetes mellitus (arm vein group, 78%; GSV group, 50% GSV; P = .02). No difference in the ischemia stage at presentation was present between the groups, with most patients presenting with stage 3 ischemia. Also, no differences in patency of hemodialysis access after DRIL between the two groups were found (P = .96). At 12 and 24 months after DRIL, 86.9% (95% confidence interval [CI], 68.3%-94.9%) and 82.0% (95% CI, 61.3%-92.3%) of patients with an arm vein conduit had access patency compared with 93.8% (95% CI, 63.2%-99.1%) and 76.9% (95% CI, 43.0%-92.2%) of those with a GSV conduit, respectively. All but one patient had symptom resolution. The incidence of wound complications was significantly greater in the GSV group than in the arm vein group (46% vs 11%; P = .003). DRIL bypass had remained patent in all but one patient in each group, with a median follow-up of 18 months (range, 1-112 months) in the arm vein conduit group and 15 months (range, 0.25-105 months) in the GSV conduit group. CONCLUSIONS DRIL procedures using an arm vein have advantages over those performed with the GSV. In our series, symptom resolution and access salvage were similar but distinctly fewer wound complications had occurred in the arm vein group. Additionally, the use of an arm vein conduit avoids the need for general anesthesia. If an ipsilateral arm vein is available, it should be the conduit of choice when performing DRIL.
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Affiliation(s)
- M Libby Weaver
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md.
| | | | - Alexis Graham
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md
| | - Thomas Reifsnyder
- Division of Vascular Surgery, Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md
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13
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Guzman RP. The systematic analysis of distal revascularization with interval ligation for dialysis access steal syndrome. J Vasc Surg 2019; 70:1374. [PMID: 31543173 DOI: 10.1016/j.jvs.2019.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/19/2019] [Indexed: 10/26/2022]
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