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Related Experiment Video

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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
07:48

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Published on: June 8, 2019

Distal revascularisation with interval ligation (DRIL): an experience.

M Field1, J Blackwell, A Jaipersad

  • 1The Vascular Unit, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK. melfield@doctors.org.uk

Annals of the Royal College of Surgeons of England
|May 5, 2009
PubMed
Summary
This summary is machine-generated.

Distal revascularisation with interval ligation (DRIL) effectively treats arteriovenous fistula (AVF) steal syndrome, preserving vascular access and alleviating ischemic symptoms. This procedure offers a successful alternative to central lines.

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Interventional Radiology

Background:

  • Increasing rates of chronic renal failure necessitate greater reliance on haemodialysis via arteriovenous fistulas (AVFs).
  • Arteriovenous fistulas can cause ischemic steal syndrome, diverting blood flow distally and causing symptoms.
  • Distal revascularisation with interval ligation (DRIL) is a described treatment for symptomatic ischemic steal.

Purpose of the Study:

  • To present clinical experience with the DRIL procedure for managing symptomatic ischemic steal in patients with AVFs.
  • To evaluate the efficacy of DRIL in preserving vascular access and resolving ischemic symptoms.

Main Methods:

  • Six patients with severe ischemic steal underwent the DRIL procedure.
  • The study included patients with elbow brachiocephalic AVFs experiencing symptoms from rest pain to gangrene.
  • A review of 135 international DRIL procedures was also conducted.

Main Results:

  • DRIL successfully maintained vascular access and eliminated ischemic symptoms in all six patients.
  • An ipsilateral reversed basilic vein graft and interval ligation of the distal brachial artery were utilized.
  • Patients demonstrated immediate and sustained clinical improvement, with increased digital pulse oximetry readings.

Conclusions:

  • DRIL is a beneficial and successful treatment for alleviating ischemic steal symptoms associated with AVFs.
  • The procedure effectively preserves vascular access, avoiding risks associated with central lines and alternative fistula creation.