Proximalization through one incision of a wrist arteriovenous fistula and distal revascularization with interval ligation

Andre Rafizadeh; Thomas Lee; Kevin James; Brian Wernick

doi:10.1016/j.jvscit.2022.10.009

Proximalization through one incision of a wrist arteriovenous fistula and distal revascularization with interval ligation

J Vasc Surg Cases Innov Tech. 2022 Nov 17;9(1):101051. doi: 10.1016/j.jvscit.2022.10.009. eCollection 2023 Mar.

Authors

Andre Rafizadeh¹, Thomas Lee¹, Kevin James¹, Brian Wernick¹

Affiliation

¹ Department of Surgery, Morristown Medical Center, Morristown, NJ.

Abstract

In the setting of ischemic steal syndrome with tissue loss, patients with radiocephalic fistulas have limited options to preserve their conduit and treat their ischemic symptoms. To address this, we have proposed the technique of proximalization through one incision of a wrist arteriovenous fistula (POWR) with distal revascularization with interval ligation (DRIL) procedure. In the present retrospective, single-center, case series, we evaluated the outcomes of three patients with radiocephalic fistulas who had undergone POWR DRIL from 2017 to 2021. Their ischemic symptoms were monitored for regression. All three patients showed signs of regressing ischemia. The POWR DRIL represents an efficient procedure to address tissue loss and preserve the autogenous conduit.

Keywords: DRIL; Ischemic steal; Proximalization; Radiocephalic fistula; Ulcer.