XXXX : a case series and review of current management.

@entity1 @entity101 @entity6 @entity63 @entity177 @entity2992 @entity292
BACKGROUND: Currently over 5000 @entity1 are receiving hemodialysis in Australia, which is an increase by approximately 7% each year. Distal @entity63 secondary to the steal syndrome ( @entity2992 ) is an uncommon but recognized complication. Several methods are now available to manage this problem including ligation, banding, and distal revascularization with interval ligation (DRIL). The aim of this report is to review the experience of the authors on this complication and its management at Royal Perth Hospital. METHODS: The Vascular Physiology Laboratory Database was used to identify those @entity1 referred for investigation of @entity2992 . Data were collected retrospectively from these @entity1 ' files concerning their demographics, graft particulars, and type of interventional procedure. @entity1 were then recalled to assess long-term patency and current venous access and for postoperative vascular studies. RESULTS: Eighteen @entity1 were identified with @entity63 symptoms. The mean age was 66 (range, 44 to 82). Fourteen (77.8%) were @entity1 , and 15 (83.3%) were @entity6 . @entity177 was secondary to @entity6 in 8 @entity1 , @entity101 in 3, and a combination of both in 7 @entity1 . Intervention was via the DRIL procedure in 12, ligation in 5, and banding in 1. One @entity1 underwent angioplasty of the ulnar artery before DRIL. At follow-up (between 1 and 12 months), all DRIL bypass were patents. The 5 ligated @entity1 all improved, and the @entity1 who underwent banding thrombosed their graft. CONCLUSION: The DRIL procedure should be considered the standard operation to manage @entity2992 in that it manages the @entity63 while maintaining the functional @entity292 . It is, however, still necessary to ligate some fistulae and seek alternative access. There are still no preoperative indicators as to who will suffer @entity2992 .
