Stenotic ligature: a simple technique for managing distal hypoperfusion ischemic syndrome following arteriovenous fistulas

Introduction. Distal Hypoperfusion Ischemic Syndrome (DHIS) is a multifactorial debilitating condition causing peripheral ischemia and potentially tissue necrosis. In an effort to further refine its surgical treatment we aim to describe a modified, simple and reliable technique for managing DHIS in patients with arteriovenous fistulas. Materials and Methods. Twenty-nine consecutive patients with DHIS operated by a single surgical team over a period of 7 years were included in the study. All patients underwent the same surgical technique: stenotic ligature. Outcomes were analyzed clinically and the effectiveness of the procedure was proven using McNemar test. Clinical variables were statistically analyzed in SPSS 17.0 for Windows. Results. The technique we used consists in performing a stenosing ligature on the vein, using a 0-silk suture, and adjusting the suture in order to achieve either a radial pulse or capillary pulse, while maintaining a good thrill at palpation of the vein. The procedure was successful in 83% of patients proved by immediate symptomatic relief. Paired data analysis showed significant decrease of all symptoms: cold extremity (p=0,021), paraesthesia (p less 0,001), pain (p less 0,001). History of coronary artery disease, arteriopathy or the absence of radial pulse is statistically correlated with an increased risk of developing DHIS. Conclusions. Stenotic ligature is a simple, cheap and reliable technique for managing DHIS with lower septic risks which can be easily performed under local anesthesia.