Strategies for predicting and treating access induced ischemic steal syndrome
G S Tynan-Cuisinier1, S S Berman
1The Southern Arizona Vascular Institute, Tucson, AZ 85704, USA.
Summary
Access-induced ischemia is a rare but serious complication for hemodialysis patients. Measuring the digital-brachial index intraoperatively can identify at-risk individuals, with the DRIL procedure often used for treatment.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access Management
Background:
- Access-induced ischemia is a severe complication in hemodialysis patients.
- Clinical risk factors for this condition have been identified.
- Intraoperative digital-brachial index (DBI) measurement can aid in risk stratification.
Purpose of the Study:
- To review the diagnosis and management of access-induced ischemia in hemodialysis patients.
- To highlight the utility of intraoperative digital-brachial index (DBI) measurement.
- To discuss surgical strategies, including the distal revascularization-interval ligation (DRIL) procedure.
Main Methods:
- Review of clinical risk factors for access-induced ischemia.
- Intraoperative measurement of the digital-brachial index (DBI) for risk assessment.
- Discussion of surgical interventions, focusing on the distal revascularization-interval ligation (DRIL) procedure and alternatives.
Main Results:
- A digital-brachial index (DBI) <0.45 may indicate patients at higher risk.
- The distal revascularization-interval ligation (DRIL) procedure is a consistently successful surgical tactic.
- DRIL aims to reverse ischemia while preserving hemodialysis access.
Conclusions:
- Access-induced ischemia requires careful patient selection and timely surgical intervention.
- The distal revascularization-interval ligation (DRIL) procedure is effective for treating this complication.
- Alternative surgical strategies are being explored and will be discussed.
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