Distal Revascularization And Interval Ligation For Femoral Arteriovenous Graft Steal Syndrome

Patients with end-stage renal disease and exhausted upper extremity options may require lower extremity arteriovenous grafts (AVGs) for hemodialysis access.We present a 62-year-old woman with a right superficial femoral artery-femoral vein looped AVG who developed limbthreatening ischemia secondary to steal syndrome.A distal revascularization and interval ligation (DRIL) procedure, using an external iliac-to-distal superficial femoral artery bypass with interval ligation, successfully restored perfusion while preserving access.The patient's ischemic symptoms resolved, and both AVG and bypass remained patent at over two years, demonstrating DRIL as an effective limb-salvaging option.