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  • Title: Surgical banding for refractory hemodialysis access-induced distal ischemia (HAIDI).
    Author: Scheltinga MR, Van Hoek F, Bruyninckx CM.
    Journal: J Vasc Access; 2009; 10(1):43-9. PubMed ID: 19340799.
    Abstract:
    Hemodialysis patients may develop distal ischemia in an extremity harboring a functioning arteriovenous access (AVA). Surgery is indicated if conservative treatment including catheter-based therapies fails. The role of surgical banding for refractory hemodialysis access-induced distal ischemia (HAIDI) is systematically reviewed (n=39 articles). If banding is executed without an intraoperative monitoring tool ("blind"), or guided by finger pressures only, clinical success and access patency rates are low (<50%). In contrast, banding is clinically successful when access flow is monitored during the operative procedure, with excellent long-term patency of banded AVA's (97%, 17 +/- 3 months). Banding is the method of choice in HAIDI patients with a normal or high access flow (>1.2 l/min) provided that flow and distal perfusion are closely monitored intraoperatively.
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