Program Book - Keck School of Medicine of USC - University of ...

Ligation may still be an option for early severe ISS, especially when the fistula has notbeen accessed and does not have a proven track record of successful access performance.Other options can then be reconsidered before committing to a more complex procedureto correct ISS.Conclusions:The development of the ischemic steal syndrome remains an important complication afterthe creation of an AV fistula. Before the description of the DRIL procedure attempts atsurgical correction often failed to correct the distal ischemia or resulted in fistulathrombosis. As a result there was a general reluctance for clinicians to fully recognize thesyndrome. In many centers this reluctance banding continue to disappoint both the patientand the surgeon. The innovative design of the DRIL procedure uniquely provides areliable means to reestablish distal perfusion without compromising fistula patency and isstrongly recommended as the procedure of choice in treating ischemic steal syndrome.PAI and RUDI procedures also hold promise for treatment of ISS in appropriatelyselected patients.12011