Distal radial artery embolization combined with recanalization and angioplasty of any present ulnar artery stenoses and occlusions may provide equivalent results with the DRIL operation, which is regarded as the most efficient and effective treatment option for correcting the hemodynamics in DASS. While coil occlusion of the distal radial artery preempts the steal phenomenon in a manner comparable to that of interval ligation, the presence of a normal or effectively angioplastied ulnar artery will offer distal blood flow with superior flows [134]. Surgical Consultation Surgical management in the setting of DASS or ischemic steal syndrome is a useful treatment option [142-146]. Surgical management of moderate-to-severe ischemic steal syndrome may be divided into 3 general categories which includes ligation (banding and plication), rerouting of arterial inflow, and restriction of flow. Surgical techniques for the treatment of DASS include DRIL, which involves ligation of the brachial artery and placement of a vein bypass to the distal brachial artery, revision using distal inflow, distal radial artery ligation, proximalization of arterial inflow, and banding [144,145]. Leake et al [145] evaluation of surgical management of DASS in 175 AV fistulas (80%), 41 upper extremity prosthetic grafts (19%), and 2 thigh grafts (1%) demonstrated that DRIL and ligation were offered to patients with the highest severity of symptoms. When compared to ligation, DRIL is equivalent in symptom resolution, with no associated increase in complications, and offers fistula preservation. When compared to banding, DRIL achieved a higher degree of fistula preservation and with a lower incidence of complications. They concluded that DRIL ought to be the preferred surgical management of DASS in patients with a functioning autologous fistula who are surgical candidates. Gupta et al [147] similarly reported their analysis of the outcomes of management of patients with ischemic steal syndrome.
Dialysis Fistula Malfunction. Distal radial artery embolization combined with recanalization and angioplasty of any present ulnar artery stenoses and occlusions may provide equivalent results with the DRIL operation, which is regarded as the most efficient and effective treatment option for correcting the hemodynamics in DASS. While coil occlusion of the distal radial artery preempts the steal phenomenon in a manner comparable to that of interval ligation, the presence of a normal or effectively angioplastied ulnar artery will offer distal blood flow with superior flows [134]. Surgical Consultation Surgical management in the setting of DASS or ischemic steal syndrome is a useful treatment option [142-146]. Surgical management of moderate-to-severe ischemic steal syndrome may be divided into 3 general categories which includes ligation (banding and plication), rerouting of arterial inflow, and restriction of flow. Surgical techniques for the treatment of DASS include DRIL, which involves ligation of the brachial artery and placement of a vein bypass to the distal brachial artery, revision using distal inflow, distal radial artery ligation, proximalization of arterial inflow, and banding [144,145]. Leake et al [145] evaluation of surgical management of DASS in 175 AV fistulas (80%), 41 upper extremity prosthetic grafts (19%), and 2 thigh grafts (1%) demonstrated that DRIL and ligation were offered to patients with the highest severity of symptoms. When compared to ligation, DRIL is equivalent in symptom resolution, with no associated increase in complications, and offers fistula preservation. When compared to banding, DRIL achieved a higher degree of fistula preservation and with a lower incidence of complications. They concluded that DRIL ought to be the preferred surgical management of DASS in patients with a functioning autologous fistula who are surgical candidates. Gupta et al [147] similarly reported their analysis of the outcomes of management of patients with ischemic steal syndrome.