Management of steal syndrome resulting from dialysis access.

Abstract

Ischemic steal secondary to a hemodialysis arteriovenous (AV) access occurs in approximately 10% of cases. The pathophysiological basis of this condition is a marked decrease or reversal of flow in the arterial segment distal to the AV fistula or AV graft, induced by the low resistance of the fistula outflow. Clinically it can manifest with either mild symptoms (coolness, paresthesia, and absence of distal pulses), or severe symptoms (rest pain, severe paresthesia, paralysis, cyanosis, and gangrene) immediately after construction of the AV access or later after its inception. Diagnosis is based on clinical manifestations, aided by the vascular laboratory and angiography. Mild cases can be observed closely, most of them will reverse in a few weeks. In order to prevent permanent sequela, severe cases require immediate intervention. Several surgical treatments have been used: access ligation, banding, elongation, distal arterial ligation, and distal revascularization-interval ligation. Best results, with maintenance of access function and reversal of symptoms, have been obtained with the distal revascularization-interval ligation procedure.

• Authors: Harry Schanzer, David Eisenberg
• Journal: Seminars in vascular surgery (Semin Vasc Surg) Vol. 17 Issue 1 Pg. 45-9 (Mar 2004) ISSN: 0895-7967 [Print] United States
• PMID: 15011179 (Publication Type: Comparative Study, Journal Article, Review)

Topics

• Arm (blood supply)
• Arteriovenous Shunt, Surgical (adverse effects, methods)
• Catheters, Indwelling (adverse effects)
• Device Removal
• Female
• Follow-Up Studies
• Humans
• Ischemia (diagnostic imaging, etiology, therapy)
• Kidney Failure, Chronic (therapy)
• Ligation (methods)
• Male
• Radiography
• Renal Dialysis (adverse effects, methods)
• Reoperation (methods)
• Severity of Illness Index
• Syndrome