Resultados del tratamiento con revascularización distal y ligadura intermedia, de la isquemia de mano después de acceso vascular para hemodiálisis

background: the creation of vascular accesses for hemodialysis can cause distal ischemia and steal syndromes. aim: to assess the effectiveness of the technique of distal revascularization-interval ligation to alleviate distal ischemia and preserve vascular access. material and methods: retrospective review of medical records, identifying 23 patients (13 women, aged between 24 and 79 years), with distal ischemia secondary to a vascular access for hemodialysis, that were treated with distal revascularization-interval liga-tion. patient characteristics and outcome of the surgical procedure were recorded. results: fourteen patients were diabetic and 15 had high blood pressure. all had the vascular access in the elbow, 20 were done with vein and three were prosthetic. steal appeared in a lapse ranging from hours to six years after performing the procedure. in 14 patients it appeared before 12 months. revascularization was performed between 1 day and three months after the appearance of the steal syndrome. seventeen patients (74%) had a substantial relief of ischemic symptoms, with healing of ulcers and digital amputations. three patients died soon after the procedure (13%). in two the pain persisted, requiring a banding of the access, that finally became thrombosed. one patient required a distal forearm amputation. thirteen patients (56%) had a late death after the procedure. after revascularization, the vascular accesses were used for a mean of two years. conclusions: revascularization-interval ligation relieves distal ischemia and maintains the patency of the vascular access for hemodialysis. patients with steal syndrome secondary to vascular access are of high risk.