Distal revascularization-interval ligation: a durable and effective treatment for XXXX after hemodialysis access.

@entity1 @entity6 @entity63 @entity2806 @entity16 @entity158
PURPOSE: The treatment of hemodialysis access-induced @entity63 is challenging. Despite promising early results with the distal revascularization-interval ligation (DRIL) procedure, the operation has not been widely adopted because of concerns about its complexity and long-term efficacy. The purpose of this report was to determine the efficacy and durability of the DRIL procedure in relieving hand @entity63 and in maintaining access patency in the setting of hemodialysis access-induced @entity63 . METHODS: A retrospective review was performed of all @entity1 who underwent the DRIL procedure for access-induced @entity63 . Demographic information was compiled, as were data regarding access and bypass patency, limb salvage, and @entity1 survival. Arteriovenous access and brachial artery bypass patency rates were determined with life-table methods. RESULTS: Between 1995 and 2001, we performed 55 DRIL procedures in 52 @entity1 (35 @entity1 and 17 @entity1 ; mean age, 60.8 years; range, 30 to 86 years). The indications for surgery were @entity158 in 27 @entity1 , tissue loss in 20 @entity1 , @entity16 in four @entity1 , and @entity158 on hemodialysis in one @entity1 . Most @entity1 (92%) had @entity6 . The mean interval from access placement to DRIL was 7.4 months (range, 1 to 84 months). The mean follow-up interval was 16 months (range, 1 to 67 months). The brachial artery bypass primary patency rate was 80% at 4 years, and the arteriovenous access primary patency rate was 83% at 1 year. Forty-seven of 52 @entity1 (90%) had substantial or complete relief of @entity63 , and 15 of 20 @entity1 with @entity2806 have healed completely. CONCLUSION: DRIL is a durable and effective procedure that reliably accomplishes the twin goals in the treatment of angioaccess-induced @entity63 : persistent relief of hand @entity63 and continued access patency.
