scholarly journals The DRIL procedure for arteriovenous access ischemic steal: a controversial approach

2016 ◽  
Vol 18 (1) ◽  
pp. 1-2 ◽  
Author(s):  
Ingemar Davidson ◽  
Gerald Beathard ◽  
Maurizio Gallieni ◽  
John Ross
Keyword(s):  
Peripheral Arterial Disease ◽  
New Technologies ◽  
Clinical Presentation ◽  
Arterial Disease ◽  
Surgical Risk ◽  
Hand Ischemia ◽  
Arterial Inflow ◽  
Arteriovenous Access ◽  
Peripheral Arterial ◽  
Over Time

The DRIL procedure first described in 1988 has long been considered the preferred treatment for arteriovenous access ischemic steal (AVAIS). At the time it was a brilliant concept and breakthrough. In the last decade, the DRIL procedure has become less used. With the increasing age of the dialysis population, patients developing AVAIS are more likely to be elderly with advanced peripheral arterial disease, making the distal revascularization anastomosis difficult and risky if not impossible to perform. In addition, the distal ligation of the main artery to the arm is something most surgeons are reluctant to do. The occlusion of the arterial bypass over time is not uncommon with recurrence of hand ischemia. The multistep DRIL procedure requires general anesthesia and the need to harvest the saphenous vein for the bypass, add to the surgical risk in patients with multiple co-morbidities. For these reasons, some surgeons prefer to do only the DR (distal re-vascularization) portion of the procedure omitting the IL (interval ligation). Increasing the bypass distance from the original anastomosis, makes this modification similar to the less invasive proximal arterial inflow (PAI) procedure. Conclusions Because of changes in the patient population clinical presentation, most notably forearm atherosclerosis and with new technologies, this editorial addresses the current validity of the DRIL procedure as a safe option in treating AVAIS.

scholarly journals Recent advances in endovascular treatment of peripheral arterial disease

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 122 ◽  
Author(s):  
Andrew Lazar ◽  
Nicholas Morrissey
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Therapy ◽  
New Technologies ◽  
Staging System ◽  
Arterial Disease ◽  
Review Article ◽  
Classification Systems ◽  
New Classification ◽  
Peripheral Arterial ◽  
Over Time

As associated co-morbidities have transformed over time, the evaluation and management of peripheral arterial disease have evolved as well. New classification systems have been created to better understand the severity of a patient’s condition and the risk of amputation. These classifications include the Wound, Ischemia, and Foot Infection (WIfI) and Global Anatomic Staging System (GLASS) classification systems. Through the utility of these systems, a patient’s disease can be appropriately staged and managed with medical, endovascular, or surgical therapies or a combination of these. Endovascular therapies specifically have grown with the explosion of new technologies. There are numerous options for patients with disease amenable to endovascular therapy. In this review article, we discuss a number of these different endovascular therapies as well as the new classification systems.

scholarly journals Review of 20 years of vascular surgery research in Australasia: Defining future directions

2019 ◽  
Vol 7 ◽  
pp. 205031211987106
Author(s):  
Judy Wang ◽  
Jasamine Coles-Black ◽  
Matija Radojcic ◽  
Jason Chuen ◽  
Philip Smart
Keyword(s):  
New Zealand ◽  
Peripheral Arterial Disease ◽  
Vascular Surgery ◽  
Case Series ◽  
Arterial Disease ◽  
Future Research ◽  
Hybrid Surgery ◽  
Peripheral Arterial ◽  
High Level ◽  
Over Time

Objectives: High-quality research is fundamental to the advancement of surgical practice. Currently, there is no quantitative assessment of the research output of vascular surgeons in Australia and New Zealand. By conducting this bibliometric analysis, we aim to provide an objective representation of the trends in vascular surgery and guide future research. Methods: A list of all current vascular surgeons in Australia and New Zealand was compiled from the Royal Australasian College of Surgeons ‘Find a Surgeon’ website tool and correlated with the Australia and New Zealand Society for Vascular Surgery database. A Scopus search of each surgeon’s author profile over the last 20 years was conducted. Results: In total, 2120 articles were published by 208 Australasian vascular surgeons between 1998 and July 2018, with an overall increase in publications over time. Audits or case series were the most published type of study and only 8% of the publications were of high-level evidence. The most popular topics were thoracoabdominal aortic pathologies (24%), followed by peripheral arterial disease (15%). Chronological analysis illustrates an increasing volume of peripheral arterial disease research over time and there is a clear trend towards more endovascular and hybrid surgery publications. The top 10 (5%) highest publishing authors by h-index account for 41% of all publications and 49% of all citations and are also responsible for producing significantly more high-level evidence research. Conclusion: Australasian vascular surgeons have made a significant contribution to medical research. However, the majority of these articles are of low-level evidence. In this time, there has been an increasing number of publications on endovascular and hybrid surgery in keeping with the trend in clinical practice. These areas, as well as research regarding peripheral arterial disease, show potential for high-evidence research in the future.

Additive prognosis of clinical presentation in revascularized peripheral arterial disease patients

2021 ◽  
Author(s):  
Fernando Garagoli ◽  
Juan G. Chiabrando ◽  
María M. Abraham Foscolo ◽  
Giuliana Corna ◽  
María de los M. Fleitas ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Clinical Presentation ◽  
Arterial Disease ◽  
Peripheral Arterial

scholarly journals Temporal Changes in Secondary Prevention and Cardiovascular Outcomes after Revascularization for Peripheral Arterial Disease in Denmark: A Nationwide Cohort Study

Circulation ◽  
2020 ◽  
Author(s):  
Mette Søgaard ◽  
Peter Brønnum Nielsen ◽  
Flemming Skjøth ◽  
Nikolaj Eldrup ◽  
Torben Bjerregaard Larsen
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Temporal Changes ◽  
Adverse Outcomes ◽  
Index Procedure ◽  
Medical Prevention ◽  
Treatment Indication ◽  
One Year ◽  
Peripheral Arterial ◽  
Over Time

Background: Patients with peripheral arterial disease (PAD) are at increased risk of cardiovascular morbidity and mortality. Medical prevention with antithrombotic and statin therapies is a mainstay of treatment to prevent adverse outcomes; nevertheless, patients with PAD are often undertreated. This study described the temporal changes in medical prevention and adverse outcomes in a national cohort of patients with symptomatic PAD after revascularization. Methods: We identified all patients with a first open surgical or endovascular revascularization procedure in the lower extremities or abdomen in Denmark, from 2000 to 2016. We examined temporal changes in the use of aspirin, clopidogrel, and statins and one-year cause-specific hazard ratios (HR) for adverse clinical outcomes, after adjusting for procedure type, treatment indication, age, sex and cardiovascular risk factors. The analyses were performed overall, and within strata of index procedure (endovascular vs. surgical), treatment indication, age, sex, and high-risk comorbidities. Results: Between 2000 and 2016, we identified 32,911 patients that underwent revascularization for symptomatic PAD. The mean age was 69 years and increased over time as did the burden of comorbidity. The cumulative incidence of medication use increased between 2000-2004 and 2013-2016, respectively, from 57.3% to 64.3% for aspirin, 3.6% to 24.8% for clopidogrel, and from 36.2% to 77.1% for statins. Concurrently, the one-year outcome rates declined. Compared with 2000-2004, the adjusted HRs in 2013-2016 were 0.73 (95% CI 0.62-0.84) for major adverse cardiovascular events, 0.92 (95% CI 0.85-1.00) for major adverse limb events, 0.60 (95% CI 0.48-0.74) for myocardial infarction, 0.94 (95% CI 0.75-1.18) for ischemic stroke, 0.92 (95% CI 0.75-1.12) for major bleeding, 0.54 (95% CI 0.39-0.76) for cardiovascular death, and 0.80 (95% CI 0.72-0.88) for all cause death. These improvements in prognosis were most prominent from 2000-2004 to 2005-2008, and occurred in all strata of index procedure, treatment indication, sex, age and comorbidity. In contrast, the adjusted HR for major amputations was 1.00 (95% CI 0.90-1.11), when comparing 2013-2016 to 2000-2004. Conclusions: Medical prevention of adverse events has increased considerably over time in patients that underwent revascularization for symptomatic PAD. This increase was accompanied by reductions in all adverse outcomes, except major amputations.

Therapeutic angiogenesis by bone marrow implantation for critical hand ischemia in patients with peripheral arterial disease: a pilot study

2006 ◽  
Vol 22 (4) ◽  
pp. 793-798 ◽  
Author(s):  
Megumi Koshikawa ◽  
Shigetaka Shimodaira ◽  
Toru Yoshioka ◽  
Hiroki Kasai ◽  
Noboru Watanabe ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Pilot Study ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Therapeutic Angiogenesis ◽  
Hand Ischemia ◽  
Peripheral Arterial
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