Department of Surgery, Huntington Hospital, Pasadena, CA, USA.
J Vasc Surg. 2013 Apr;57(4):1073-8; discussion 1078. doi: 10.1016/j.jvs.2012.10.085. Epub 2013 Jan 29.
Arterial steal syndrome after angioaccess surgery can lead to potentially devastating complications. Past treatments either ensured loss of the newly created access through ligation or attempted salvage by increasing resistance within the fistula. None of these proved to be entirely satisfactory. In 1994, we began to employ distal revascularization with interval ligation (DRIL) as our primary method of relieving hand ischemia after dialysis access creation. Described here is our experience with this procedure.
After institutional review board approval, the charts of patients undergoing the DRIL procedure for relief of hand ischemia after dialysis access surgery were reviewed. Patient demographics, risk factors, types of fistulas, and indications for operation were recorded. The clinical results of DRIL surgery, as well as fistula and bypass graft patency, were noted.
Between May 1994 and August 2011, 81 DRIL procedures were performed on 77 patients ranging from 37 to 94 (mean, 65) years of age. Forty-four were female and 33 were male, with diabetes present in 83.3%. DRIL procedures were performed for ischemic symptoms after 37 autogenous brachiocephalic, 30 prosthetic bridge, and 14 autogenous brachiobasilic fistulas. Thirty-eight DRIL procedures were performed for ischemic rest pain (46.9%), 21 for digital ulceration (25.9%), 16 for neurological deficits (19.7%), and six for digital gangrene (7.4%). Complete symptom resolution was seen in 31 patients with ischemic rest pain (81.6%), 19 patients with digital ulcerations (90.5%), nine patients with neurological deficits (56.3%), and five patients with digital gangrene (83.3%). Fistula and brachial-brachial bypass survival 60 months after the DRIL procedure was 56% and 96.9%, respectively. The overall complication rate was 17.2%, and no patients died within 30 days of operation.
The DRIL procedure is a very effective treatment for symptomatic steal syndrome and is associated with low morbidity and mortality. It is extremely effective in the treatment of ischemic hand pain and tissue loss, but less so for neurological sequelae. It can allow for prolonged fistula utilization.
血管盗血综合征在血管通路手术后可能导致潜在的破坏性并发症。过去的治疗方法要么通过结扎导致新创建的通路丧失，要么试图通过增加瘘管内的阻力来挽救。这些方法都没有完全令人满意。1994 年，我们开始采用远端再血管化联合间隔结扎（DRIL）作为透析通路手术后缓解手部缺血的主要方法。本文介绍了我们使用这种方法的经验。
在机构审查委员会批准后，回顾了接受 DRIL 手术以缓解透析通路手术后手部缺血的患者的图表。记录了患者的人口统计学、危险因素、瘘管类型和手术指征。注意 DRIL 手术的临床结果以及瘘管和旁路移植通畅情况。
1994 年 5 月至 2011 年 8 月，对 77 例年龄 37 至 94 岁（平均 65 岁）的患者进行了 81 次 DRIL 手术。44 例为女性，33 例为男性，83.3%的患者有糖尿病。DRIL 手术是为了治疗 37 例自体头臂动静脉瘘、30 例人工桥接血管瘘和 14 例自体肱动脉-肱动脉瘘术后出现的缺血症状而进行的。38 次 DRIL 手术是为了治疗缺血性静息痛（46.9%），21 次是为了治疗指溃疡（25.9%），16 次是为了治疗神经功能缺损（19.7%），6 次是为了治疗指坏疽（7.4%）。31 例缺血性静息痛患者（81.6%）、19 例指溃疡患者（90.5%）、9 例神经功能缺损患者（56.3%）和 5 例指坏疽患者（83.3%）完全缓解了症状。DRIL 手术后 60 个月，瘘管和肱动脉-肱动脉旁路的存活率分别为 56%和 96.9%。总的并发症发生率为 17.2%，没有患者在术后 30 天内死亡。
DRIL 手术是治疗症状性盗血综合征的一种非常有效的方法，具有低发病率和死亡率。它在治疗手部缺血性疼痛和组织损失方面非常有效，但对神经后遗症的效果较差。它可以延长瘘管的使用时间。
