Journal of vascular surgery | 2019
A systematic review of distal revascularization and interval ligation for the treatment of vascular access-induced ischemia.
Abstract
OBJECTIVE\nVascular access-induced ischemia remains a rare but significant complication of arteriovenous fistulas. Distal revascularization and interval ligation (DRIL) is one form of treatment. However, its collated efficacy through a systematic review is yet to be established.\n\n\nMETHODS\nAn electronic and systematic search of the literature in MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane Library from 1966 to 2017 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Quality assessment of the articles was performed using the Oxford Critical Appraisal Skills Programme, and the recommendation for practice was examined through the National Institute for Health and Care Excellence. Data of treated cases, success, time to ischemia, follow-up, age, sex, diabetes mellitus, fistula type, conduit type, and grade of ischemia were extracted and subjected to a pooled variance-weighted random-effects model.\n\n\nRESULTS\nTwenty-two studies (n\xa0= 459 individuals) were subjected to DRIL. Time to ischemia was 196\xa0days (interquartile range, 30-600\xa0days). Ischemia grade 3/4 (52%) was the most common presentation. The overall success (grades 1-4) was 81% (95% confidence interval, 80.9%-82.5%) during a mean and median follow-up of 22.2\xa0months (interquartile range, 1-60\xa0months) and 18\xa0months, respectively. The conduit of choice was the great saphenous vein (n\xa0= 300/459 [65%]), and bypass thrombosis was highest in the polytetrafluoroethylene group (n\xa0= 19/44 [43%]).\n\n\nCONCLUSIONS\nDRIL with adequate long-term outcomes is an effective technique for the treatment of vascular access-induced ischemia.