Gumus et al [128] reported 21 patients who underwent endovascular occlusion of their native fistulas. Of the studied patients, 2 patients had hyperdynamic heart failure, 2 exhibited DASS and 5 patients had findings of critical hand ischemia with a nonhealing ulcer or necrosis. Successful embolization of all fistulas using AMPLATZER vascular plugs were performed with no immediate or delayed complications with a mean follow-up of 13.5 months. Dialysis Fistula Malfunction In forearm and wrist fistulae, cases of DASS occur at a rate of 1%, and is referred to as palmar arch steal syndrome. While digital revascularization with interval ligation (DRIL) is the most accepted technique with the highest success of correcting signs of steal phenomenon while preserving access patency, it is technically difficult and has a small chance of success when employed in wrist fistulae. This is due to the notably reduced diameter of the associated arteries that may also contain calcific disease in at-risk persons [134]. As such, in forearm AVF, surgical ligation or endovascular embolization of the radial artery distal to the anastomosis are helpful treatment options. Miller et al reported endovascular coil embolization in 10 patients while surgical ligation was conducted in 5 patients. Improvement in symptoms was noted in each of the patients in the endovascular group versus 3 patients in the group which underwent ligation [141]. Advantages of endovascular management include its minimally invasive nature, its ability to be performed concomitantly with diagnostic angiography, and the capacity for performing occlusion of both the distal radial artery as well as any other culprit branches. The ability to perform angioplasty on additional stenoses augments blood flow to the fistula and hand. Endovascular dilation is achievable in the palmar arch arteries and distal forearm where surgical revascularization is routinely not possible.
Dialysis Fistula Malfunction. Gumus et al [128] reported 21 patients who underwent endovascular occlusion of their native fistulas. Of the studied patients, 2 patients had hyperdynamic heart failure, 2 exhibited DASS and 5 patients had findings of critical hand ischemia with a nonhealing ulcer or necrosis. Successful embolization of all fistulas using AMPLATZER vascular plugs were performed with no immediate or delayed complications with a mean follow-up of 13.5 months. Dialysis Fistula Malfunction In forearm and wrist fistulae, cases of DASS occur at a rate of 1%, and is referred to as palmar arch steal syndrome. While digital revascularization with interval ligation (DRIL) is the most accepted technique with the highest success of correcting signs of steal phenomenon while preserving access patency, it is technically difficult and has a small chance of success when employed in wrist fistulae. This is due to the notably reduced diameter of the associated arteries that may also contain calcific disease in at-risk persons [134]. As such, in forearm AVF, surgical ligation or endovascular embolization of the radial artery distal to the anastomosis are helpful treatment options. Miller et al reported endovascular coil embolization in 10 patients while surgical ligation was conducted in 5 patients. Improvement in symptoms was noted in each of the patients in the endovascular group versus 3 patients in the group which underwent ligation [141]. Advantages of endovascular management include its minimally invasive nature, its ability to be performed concomitantly with diagnostic angiography, and the capacity for performing occlusion of both the distal radial artery as well as any other culprit branches. The ability to perform angioplasty on additional stenoses augments blood flow to the fistula and hand. Endovascular dilation is achievable in the palmar arch arteries and distal forearm where surgical revascularization is routinely not possible.