A comparison of revision using distal inflow and distal revascularization-interval ligation for the management of severe access-related hand ischemia

Journal of Vascular Surgery
Jonathan MisskeyYork Hsiang

Abstract

Access-related hand ischemia (ARHI) is a potentially limb-threatening complication of arteriovenous access for dialysis. The distal revascularization-interval ligation (DRIL) and revision using distal inflow (RUDI) procedures both allow treatment of ischemic symptoms while maintaining fistula patency. Although outcomes with the DRIL are well established, experience with the RUDI for ARHI remains preliminary. We compared outcomes in these procedures with respect to cumulative patency, resolution of symptoms, and patient survival. A large, prospectively maintained database was used to identify all patients after autogenous arteriovenous fistula construction at two hospitals between 2005 and 2015. Patients with severe Society for Vascular Surgery grade 3 ARHI were included for analysis. A total of 2035 autogenous accesses were created during the study period, and 58 (3%) developed grade 3 ARHI. Of this cohort, RUDI was performed in 20 and DRIL in 21. The indication for intervention was tissue loss (61%) or ischemic rest pain (39%). Mean age was 57.5 years, and 54% of patients were female. Most patients had diabetes (86%) and symptomatic peripheral arterial disease (63%). The mean preoperative digital-brachial index was 0.25 ± 0.12...Continue Reading

References

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Dec 17, 2014·Journal of Vascular Surgery·Andrew E LeakeEllen D Dillavou

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Citations

Feb 14, 2018·Anesthesiology·Asha SinghAndra E Duncan
Mar 16, 2017·The Journal of Vascular Access·Ahmed S Mohamed, Eric K Peden
Sep 12, 2018·The Journal of Vascular Access·Susanne RegusUlrich Rother
Jan 15, 2019·Annals of Vascular Diseases·Ali KordzadehAli Davod Parsa
Jun 27, 2020·The Journal of Vascular Access·Michael W M GerrickensMarc R M Scheltinga

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