الفهرس 
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Abstract
The aim of this study was to compare the efficacy and the patency of venous banding and Distal Revascularization with Interval Ligation (DRIL) in treating steal syndrome after A-V fistula creation for hemodialysis in end stage renal disease patients.
Twenty patients were included in this study (11 females and 9 males) with mean age was 53.10 ± 14.23 year. 11 patients were diabetics (55%), 2 patients were smokers (10%) and 2 patients had previous A-V fistula in the same limb (10%) with all of the patients were presented with brachial fistulas.
25% of the patients were complaining of severe pain and cyanosis during hemodialysis (steal stage II), 40% of the patients complained from rest pain (steal stage III) and 35% of the patients were presented with skin changes and gangrene (steal stage IV).
The study group was subdivided equally into two groups; group A treated with venous banding and group B treated with DRIL.
• Venous banding is to narrow the first few centimeters of the venous limb by polytetrafloroethelyne (PTFE) graft or by nylon tape or with prolene mesh till there is a functioning access with a better distal flow.
• DRIL is to ligate the brachial artery just distal to the AV fistula and make a bypass from the artery 5 cm proximal to the fistula to the artery distal to the site of ligation.
The mean blood flow volume across the access before treatment was 2970.0 ± 636.05 in group (A) patients and 3060.0 ± 544.06 in group (B) and significantly decreased to 1550.0 ± 635.09 in group (A) and 1990.0 ± 267.69 in group (B) with a significant increase in the flow in the distal artery from 9.90 ± 3.90 to 33.60 ± 8.26 in group (A) and from 9.40 ± 2.99 to 38.50 ± 8.13 in group (B).
The mean oxygen saturation by finger oximetry in group (A) increased from 91.90 ± 2.64 to 97.80 ± 1.14 and increased from 89.90 ± 8.54 to 97.90 ± 1.37 in group (B).
2 cases in group (A) treated with venous banding lost their accesses due to hypofunctioning fistulas with a patency 80% in three months follow up. while all the cases of group (B) had patent accesses all through the period of follow up with 100% patency and this reflects the higher patency rate and efficacy of DRIL than venous banding in treating hemodialysis steal symptoms.
Postoperatively and in three month follow up , 5 of 8 patients in group (A) had complete resolution of symptoms with efficacy reaching 62.5% while all the patients in group (B) treated with DRIL had complete resolution of ischemic complaints postoperatively and follow up for 3 months reaching 100% efficacy.