A 68-year-old diabetic woman develops severe pain in her left hand during haemodialysis through a radiocephalic arteriovenous fistula created six months ago. The hand is cool with weakened digital pulses between dialysis sessions. Which procedure directly addresses the mechanism of this complication?
- A Fistula ligation with permanent catheter placement
- B Distal revascularisation and interval ligation (DRIL) ✓
- C Sympathectomy of the affected limb
- D Conversion of the fistula to an arteriovenous graft in the thigh
Correct answer: B. Distal revascularisation and interval ligation (DRIL)
Explanation
Access induced steal syndrome arises because the low resistance fistula diverts arterial blood away from the hand, causing ischaemic pain worst during dialysis. Diabetes and advanced age are major risk factors. The DRIL procedure ligates the artery just distal to the anastomosis and constructs a bypass from proximal to distal artery around it, restoring antegrade perfusion to the hand while preserving the access. Simple ligation sacrifices a functioning fistula unnecessarily.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.