Dril Procedure: Treatment for Vascular Access Induced Hand Ischemia. Case Report

Native vascular access (AVF arteriovenous fistula) for chronic hemodialysis (CH) performed proximally to the diabetic patient, between the brachial artery and the basilic vein or cephalic vein, determines the risk of distal (hand) ischemia. The correction of the ischemia can be done differently depending on its severity, starting from the vasodilator medication, reaching the cancellation of the vascular access with the accomplishment of the chronic hemodialysis on the central venous catheter. DRIL procedure (Distal Revascularization and Interval Ligation) corrects distal ischemia while maintaining functional vascular access, an important aspect in diabetic patients in whom vascular capital is deficient. We further describe a case of a diabetic patient with right L-T brachiocephalic arteriovenous fistula, with important ischemic phenomena in which the DRIL procedure resolved the ischemia, the patient using vascular access as usual, the second postoperative day.