Does a failed DRIL mean the end for a fistula? A case report in the use of an Amplatzer plug post DRIL procedure for ongoing steal syndrome

Abstract

Dialysis access steal syndrome is a well-recognised complication, affecting 1%–8% of all patients who undergo arteriovenous fistula formation particularly those that are brachial based. We present a case of ongoing steal syndrome following a DRIL procedure via retrograde flow in the ulnar artery. This was managed via a hybrid procedure and the use of an Amplatzer plug. This case demonstrates a novel use for the Amplatzer occlusion device, it is also a reminder that failure to occlude the vessel close to the fistula anastomosis can result in continued steal despite a functioning DRIL bypass.

The enduring success of the DRIL technique and new advances in dialysis access

“…Other endovascular devices, such as drug-coated balloons, covered stents, and coils, have improved surgeons’ ability to maintain access patency and supplement operations like DRIL. 10 , 11 Endovascular AVF creation in the mid- to proximal-forearm has been shown to have promising early results in recent trials. 11 Its side-to-side anastomosis reduces shear stress, which, coupled with the avoidance of manual tissue handling, reduces the risk of developing neointimal hyperplasia (NIH) and subsequent stenosis and/or thrombosis.…”