Berman distal revascularization-interval

Transcription

1 distal revascularization-interval ligation DRIL mmhg 35 distal revascularization-interval ligation DRIL 90mmHg 0.56 DRIL dialysis access-associated steal syndrome DASS DASS Schanzer 2 Berman distal revascularization-interval ligation DRIL DASS Tel: DRIL mg/dl mm

2 13 4 Fig. 1 Preoperative left brachial arteriogram revealed that the radial artery was patent to the wrist with several subcritical stenoses and the ulnar artery was occluded 2cm distal from its origin when manual compression was applied at the arterio-venous anastomosis of the angioaccess. Fig. 2 The reversed saphenous vein bypass grafting was constructed from the middle portion to the bifurcation of the brachial artery. The vein graft was placed in the medial aspect of the elbow joint so as to avoid kinking of the graft with elbow flexion. The interval between the arterio-venous fistula and the distal anastomosis of the bypass grafting was clamped in this picture, which was subsequently ligated cm Fig DRIL tumescent local anesthesia TLA 1 / 3 5 cm 12cm 6-0 Fig. 2 40ml/min 60ml/min 28

3 DRIL Table 1 Results of distal revascularization-interval ligation (DRIL) for the treatment of dialysis access-associated steal syndrome. Author Year No. of cases Success (%) bypass patancy (%) AVF patency (%) Follow-up period Diehl et al. 4) mo mo mo Knox et al. 5) mo NA mo 80 NA 48 mo Sessa et al. 6) mo (mean 5.5 mo) Stierli et al. 7) mo (mean NA) Berman et al. 3) mo Katz et al. 8) mo (mean 7.4 mo) Haimov et al. 9) mo mo Schanzer et al. 10) mo NA: not available 90mmHg 160mmHg 0.56 DASS ) 10mm 7 mm 1) 6 mm 8 mm DASS < 50mmHg < DASS Duplex Lazarides ,6 banding Odland 16 DASS 50mmHg 0.6 banding

4 13 4 cm 3 cm 11 5 cm mmHg > ml/min Duplex distal revascularization-interval ligation DRIL 1 Tordoir, J. H. M., Dammers, R. and van der Sande, F. M.: Upper extremity ischemia and hemodialysis vascular access. Eur. J. Vasc. Endovasc. Surg., 27: 1-5, Schanzer, H., Schwartz, M., Harrington, E., et al.: Treatment of ischemia due to steal by arteriovenous fistula with distal artery ligation and revascularization. J. Vasc. Surg., 7: , Berman, S. S., Gentile, A. T., Glickman, M. H., et al.: Distal revascularization-interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome. J. Vasc. Surg., 26: , Diehl, L., Johansen, K. and Watson, J.: Operative management of distal ischemia complicating upper extremity dialysis access. Am. J. Surg., 186: 17-19, Knox, R. C., Berman, S. S., Hughes, J. D., et al.: Distal revascularization-interval ligation: a durable and effective treatment for ischemic steal syndrome after hemodialysis access. J. Vasc. Surg., 36: , Sessa, C., Pecher, M., Maurizi-Balzan, J., et al.: Critical hand ischemia after angioaccess surgery: diagnosis and treatment. Ann. Vasc. Surg., 14: , Stierli, P., Blumberg, A., Pfister, J., et al.: Surgical treatment of steal syndrome induced by arteriovenous grafts for hemodialysis. J. Cardiovasc. Surg., 39: , Katz, S. and Kohl, R. D.: The treatment of hand ischemia by arterial ligation and upper extremity bypass after angioaccess surgery. J. Am. Coll. Surg., 183: , Haimov, M., Schanzer, H. and Skladani, M.: Pathogenesis and management of upper-extremity ischemia following angioaccess surgery. Blood Purif., 14: , Schanzer, H., Skladany, M. and Haimov, M.: Treatment of angioaccess-induced ischemia by revascularization. J. Vasc. Surg., 16: , Wixon, C. L., Mills, J. L. Sr and Berman, S. S.: Distal revascularization-interval ligation for maintenance of dialysis access and restoration of distal perfusion in ischemic steal syndrome. Semin. Vasc. Surg., 13: 77-82, Lazarides, M. K., Staamos, D. N., Panagopoulos, G. N., et al.: Indications for surgical treatment of angioaccess-induced arterial steal. J. Am. Coll. Surg., 187: , Odland, M. D., Kelly, P. H., Ney, A. L., et al.: Management of dialysis-associated steal syndrome complicating upper extremity arteriovenous fistulas: use of intraoperative digital photoplethysmography. Surgery, 110: ,

5 DRIL A Case of Distal Revascularization-Interval Ligation for Dialysis Access-Associated Steal Syndrome Norihide Sugano, Yoshinori Inoue, Masatoshi Jibiki and Takehisa Iwai Department of Surgery, Tokyo Medical and Dental University, Graduate School Key words: Hemodialysis, Vascular Access, Steal Syndrome, Hand Ischemia A 75-year-old man was referred due to rest pain and weakness of his left hand. His past history included diabetes mellitus, carcinoma of the urinary bladder and right femoro-popliteal bypass grafting for digital necroses of his right foot. A vascular access was created at his elbow on November Coldness and numbness of his left forearm appeared approximately 10 days after the surgery and weakness of his left hand also appeared 10 days after that. The systolic pressure of his left forearm was 0 mmhg. The left brachial arteriogram could not reveal the radial artery without manual compression of the arterio-venous anastomosis. Distal revascularization-interval ligation (DRIL) was performed 35 days after the first surgery because of severe rest pain in his left upper extremity. Immediately after the revascularization, rest pain and weakness of his left hand improved. The left forearm blood pressure increased to 90 mmhg and the pressure ratio became 0.56, which was calculated by dividing the forearm pressure with the contralateral arm pressure. DRIL for dialysis access-associated steal syndrome seemed to be an effective treatment, which improved ischemic symptoms with a minimum risk of vascular access occlusion. Jpn. J. Vasc. Surg., 13: ,