Surgical techniques for haemodialysis access-induced distal ischaemia

Julien Al Shakarchi, Jan Stolba, J Graeme Houston, Nicholas Inston

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    PURPOSE: Haemodialysis access-induced distal ischaemia (HAIDI) is a significant complication of vascular access creation, and has traditionally been difficult to manage without loss of access. Current treatment options include ligation, banding, distal revascularisation with interval ligation (DRIL), proximalisation of the arterial inflow (PAI) and revision using distal flow (RUDI). The purpose of this review was to evaluate the effectiveness of the different surgical techniques in the treatment of HAIDI.

    METHODS: Electronic databases were searched for studies assessing surgical techniques in the treatment of HAIDI in accordance with PRISMA. The primary outcome for the study was symptomatic relief for each technique, defined within each study. Secondary outcomes included comparison of early thrombosis rates following each different procedure.

    RESULTS: Following strict inclusion/exclusion criteria by two reviewers, twenty-seven studies of surgical interventions were included and divided into subgroups for banding, DRIL, PAI and RUDI procedures. Both DRIL and banding procedures were found to have high rates of symptomatic relief. In addition, the DRIL has a significantly lower rate of early thrombosis than banding although the more recent papers seem to suggest that early thrombosis is less of a problem in banding. PAI and RUDI showed some promise but there were too few studies to be able to make any clear conclusions.

    CONCLUSIONS: All four procedures have high success rate in relieving ischaemic symptoms with the DRIL procedure having a significantly better vascular access patency rate than other techniques, although further well designed studies are required to compare all four surgical techniques.

    Original languageEnglish
    Pages (from-to)40-6
    Number of pages7
    JournalJournal of Vascular Access
    Volume17
    Issue number1
    Early online date5 Sep 2015
    DOIs
    Publication statusPublished - 28 Jan 2016

    Fingerprint

    Ligation
    Renal Dialysis
    Ischemia
    Thrombosis
    Vascular Patency
    Blood Vessels
    Therapeutics
    Outcome Assessment (Health Care)
    Databases

    Keywords

    • Arteriovenous Shunt, Surgical
    • Blood Vessel Prosthesis Implantation
    • Endovascular Procedures
    • Graft Occlusion, Vascular
    • Humans
    • Ischemia
    • Ligation
    • Regional Blood Flow
    • Renal Dialysis
    • Reoperation
    • Risk Factors
    • Treatment Outcome
    • Vascular Patency
    • Journal Article
    • Research Support, Non-U.S. Gov't
    • Review

    Cite this

    Al Shakarchi, Julien ; Stolba, Jan ; Houston, J Graeme ; Inston, Nicholas. / Surgical techniques for haemodialysis access-induced distal ischaemia. In: Journal of Vascular Access. 2016 ; Vol. 17, No. 1. pp. 40-6.
    @article{e885d73825084a46a0345fa51c4049e8,
    title = "Surgical techniques for haemodialysis access-induced distal ischaemia",
    abstract = "PURPOSE: Haemodialysis access-induced distal ischaemia (HAIDI) is a significant complication of vascular access creation, and has traditionally been difficult to manage without loss of access. Current treatment options include ligation, banding, distal revascularisation with interval ligation (DRIL), proximalisation of the arterial inflow (PAI) and revision using distal flow (RUDI). The purpose of this review was to evaluate the effectiveness of the different surgical techniques in the treatment of HAIDI.METHODS: Electronic databases were searched for studies assessing surgical techniques in the treatment of HAIDI in accordance with PRISMA. The primary outcome for the study was symptomatic relief for each technique, defined within each study. Secondary outcomes included comparison of early thrombosis rates following each different procedure.RESULTS: Following strict inclusion/exclusion criteria by two reviewers, twenty-seven studies of surgical interventions were included and divided into subgroups for banding, DRIL, PAI and RUDI procedures. Both DRIL and banding procedures were found to have high rates of symptomatic relief. In addition, the DRIL has a significantly lower rate of early thrombosis than banding although the more recent papers seem to suggest that early thrombosis is less of a problem in banding. PAI and RUDI showed some promise but there were too few studies to be able to make any clear conclusions.CONCLUSIONS: All four procedures have high success rate in relieving ischaemic symptoms with the DRIL procedure having a significantly better vascular access patency rate than other techniques, although further well designed studies are required to compare all four surgical techniques.",
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    year = "2016",
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    doi = "10.5301/jva.5000467",
    language = "English",
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    Surgical techniques for haemodialysis access-induced distal ischaemia. / Al Shakarchi, Julien; Stolba, Jan; Houston, J Graeme; Inston, Nicholas.

    In: Journal of Vascular Access, Vol. 17, No. 1, 28.01.2016, p. 40-6.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Surgical techniques for haemodialysis access-induced distal ischaemia

    AU - Al Shakarchi, Julien

    AU - Stolba, Jan

    AU - Houston, J Graeme

    AU - Inston, Nicholas

    N1 - Financial support: ReDVA has been supported by the EU FP7 IAAP funding.

    PY - 2016/1/28

    Y1 - 2016/1/28

    N2 - PURPOSE: Haemodialysis access-induced distal ischaemia (HAIDI) is a significant complication of vascular access creation, and has traditionally been difficult to manage without loss of access. Current treatment options include ligation, banding, distal revascularisation with interval ligation (DRIL), proximalisation of the arterial inflow (PAI) and revision using distal flow (RUDI). The purpose of this review was to evaluate the effectiveness of the different surgical techniques in the treatment of HAIDI.METHODS: Electronic databases were searched for studies assessing surgical techniques in the treatment of HAIDI in accordance with PRISMA. The primary outcome for the study was symptomatic relief for each technique, defined within each study. Secondary outcomes included comparison of early thrombosis rates following each different procedure.RESULTS: Following strict inclusion/exclusion criteria by two reviewers, twenty-seven studies of surgical interventions were included and divided into subgroups for banding, DRIL, PAI and RUDI procedures. Both DRIL and banding procedures were found to have high rates of symptomatic relief. In addition, the DRIL has a significantly lower rate of early thrombosis than banding although the more recent papers seem to suggest that early thrombosis is less of a problem in banding. PAI and RUDI showed some promise but there were too few studies to be able to make any clear conclusions.CONCLUSIONS: All four procedures have high success rate in relieving ischaemic symptoms with the DRIL procedure having a significantly better vascular access patency rate than other techniques, although further well designed studies are required to compare all four surgical techniques.

    AB - PURPOSE: Haemodialysis access-induced distal ischaemia (HAIDI) is a significant complication of vascular access creation, and has traditionally been difficult to manage without loss of access. Current treatment options include ligation, banding, distal revascularisation with interval ligation (DRIL), proximalisation of the arterial inflow (PAI) and revision using distal flow (RUDI). The purpose of this review was to evaluate the effectiveness of the different surgical techniques in the treatment of HAIDI.METHODS: Electronic databases were searched for studies assessing surgical techniques in the treatment of HAIDI in accordance with PRISMA. The primary outcome for the study was symptomatic relief for each technique, defined within each study. Secondary outcomes included comparison of early thrombosis rates following each different procedure.RESULTS: Following strict inclusion/exclusion criteria by two reviewers, twenty-seven studies of surgical interventions were included and divided into subgroups for banding, DRIL, PAI and RUDI procedures. Both DRIL and banding procedures were found to have high rates of symptomatic relief. In addition, the DRIL has a significantly lower rate of early thrombosis than banding although the more recent papers seem to suggest that early thrombosis is less of a problem in banding. PAI and RUDI showed some promise but there were too few studies to be able to make any clear conclusions.CONCLUSIONS: All four procedures have high success rate in relieving ischaemic symptoms with the DRIL procedure having a significantly better vascular access patency rate than other techniques, although further well designed studies are required to compare all four surgical techniques.

    KW - Arteriovenous Shunt, Surgical

    KW - Blood Vessel Prosthesis Implantation

    KW - Endovascular Procedures

    KW - Graft Occlusion, Vascular

    KW - Humans

    KW - Ischemia

    KW - Ligation

    KW - Regional Blood Flow

    KW - Renal Dialysis

    KW - Reoperation

    KW - Risk Factors

    KW - Treatment Outcome

    KW - Vascular Patency

    KW - Journal Article

    KW - Research Support, Non-U.S. Gov't

    KW - Review

    U2 - 10.5301/jva.5000467

    DO - 10.5301/jva.5000467

    M3 - Article

    VL - 17

    SP - 40

    EP - 46

    JO - Journal of Vascular Access

    JF - Journal of Vascular Access

    SN - 1129-7298

    IS - 1

    ER -