Proximalization of the arterial inflow (PAI) in patients with dialysis access-induced ischemic syndrome: First report on long-term clinical results

Purpose: Proximalization of the arterial inflow (PAI) is a promising technique which was introduced several years ago as a treatment option for patients with dialysis access-induced ischemic syndrome (DAIIS). In our institutions we have been performing PAI since 2003 and have seen positive clinical results. The aim of this prospective survey is to present the long-term results of PAI. Methods: Between 2003 and 2008, forty PAI operations were performed in our institutions: 4 patients had acute pain and sensorimotor dysfunction with no lesions, 33 had small acral lesions, and 3 had extended lesions following the creation of autogenous fistulas. In 22 cases a heparinized graft was used and in 18 cases a regular PTFE-graft. Criteria for successful treeatment of the disease course were evaluated by clinical and ultrasound examinations. Results: In 36 cases (90%), PAI led to clinical success which was permanent in 33 patients (82%) seen in the follow-up period of 9 to 40 months. Primary patency was 62% after 12 months and secondary patency was 75% after 18 months. Heparinized grafts led to better patency rates. In 3 out of the 4 patients with large acral lesions, graft explantation was necessary due to infection or failing success. Conclusions: Based on our experience, clinical long-term results are successful in certain patients with DAIIS. The aim for the near future should be a better patency rate to minimize the need for reoperations. In cases of extended limb necrosis/gangrene results were poor. In such patients primary closure of the access must be discussed.