Vikrant Thakur, Rajkiran Deshpande and Tushar Patial
Distal Hypoperfusion Ischemia Syndrome (DHIS), commonly referred to as Dialysis Access Steal Syndrome, is a significant vascular complication associated with haemodialysis access procedures, affecting up to 8% of patients with end-stage renal disease (ESRD). Characterized by retrograde blood flow and reduced perfusion in the distal extremity, DHIS manifests in varying severities, ranging from mild ischemic symptoms to critical tissue necrosis. Risk factors include advanced age, diabetes mellitus, and the use of brachial artery-based arteriovenous (AV) access.
This review comprehensively examines the pathophysiology, risk factors, clinical presentation, and diagnostic modalities for DHIS. The condition’s diagnosis relies on patient symptoms, clinical staging, and imaging techniques, with angiography considered the gold standard. Differential diagnoses, including conditions such as ischemic monomelic neuropathy and calciphylaxis, are explored for accurate distinction.
Treatment strategies are outlined based on the severity of ischemia, ranging from endovascular interventions like percutaneous transluminal angioplasty to advanced surgical techniques, including banding, ligation, and procedures such as Distal Revascularization with Interval Ligation (DRIL), Proximal Arteriovenous Anastomosis (PAVA), Revision Using Distal Inflow (RUDI), and the minimally invasive MILLER technique. These methods aim to restore distal perfusion while preserving dialysis functionality, with each technique tailored to specific patient needs.
The increasing prevalence of ESRD and the aging patient population underscore the importance of early detection and individualized management of DHIS to improve patient outcomes and preserve quality of life. Further research into optimized, patient-specific interventions is critical for advancing care in this challenging condition.
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