Distal revascularization-interval ligation for the treatment of angioaccess-induced ischemia. Case report

Two cases of upper extremity ischemia due to a steal phenomenon occurring after the creation of an arterio-venous fistula (AVF) for hemodialysis access are described. A successful treatment with a brachial to brachial artery vein bypass and a ligation of the artery distal to the AVF origin (DRIL-Procedure) was performed in both cases. Complete disappearance of symptoms and healing of the ischemic lesions with maintaining of the angioaccess patency 6 months after the repair reveal that this procedure corrected the stealing.