Dialysis Access-Associated Steal Syndrome and Management

Stoecker, Jordan B.; Li, Xin; Clark, Timothy W.I.; Mantell, Mark P.; Trerotola, Scott O.; Vance, Ansar Z.

doi:10.1007/s00270-023-03462-6

Cited by 7 publications

(2 citation statements)

References 55 publications

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“…This phenomenon, often referred to as the steal syndrome, can occur in up to 1% to 8% of patients with arteriovenous access. It can cause both acute and chronic ischemia, with the symptoms ranging from finger numbness and skin mottling to rest pain and tissue loss that can lead to amputation (Figure 4A and B) …”

Section: Arteriovenous Access Complicationsmentioning

confidence: 99%

Arteriovenous Access for Hemodialysis

Lok,

Huber,

Orchanian-Cheff

et al. 2024

JAMA

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ImportanceHemodialysis requires reliable vascular access to the patient’s blood circulation, such as an arteriovenous access in the form of an autogenous arteriovenous fistula or nonautogenous arteriovenous graft. This Review addresses key issues associated with the construction and maintenance of hemodialysis arteriovenous access.ObservationsAll patients with kidney failure should have an individualized strategy (known as Patient Life-Plan, Access Needs, or PLAN) for kidney replacement therapy and dialysis access, including contingency plans for access failure. Patients should be referred for hemodialysis access when their estimated glomerular filtration rate progressively decreases to 15 to 20 mL/min, or when their peritoneal dialysis, kidney transplant, or current vascular access is failing. Patients with chronic kidney disease should limit or avoid vascular procedures that may complicate future arteriovenous access, such as antecubital venipuncture or peripheral insertion of central catheters. Autogenous arteriovenous fistulas require 3 to 6 months to mature, whereas standard arteriovenous grafts can be used 2 to 4 weeks after being established, and “early-cannulation” grafts can be used within 24 to 72 hours of creation. The prime pathologic lesion of flow-related complications of arteriovenous access is intimal hyperplasia within the arteriovenous access that can lead to stenosis, maturation failure (33%-62% at 6 months), or poor patency (60%-63% at 2 years) and suboptimal dialysis. Nonflow complications such as access-related hand ischemia (“steal syndrome”; 1%-8% of patients) and arteriovenous access infection require timely identification and treatment. An arteriovenous access at high risk of hemorrhaging is a surgical emergency.Conclusions and RelevanceThe selection, creation, and maintenance of arteriovenous access for hemodialysis vascular access is critical for patients with kidney failure. Generalist clinicians play an important role in protecting current and future arteriovenous access; identifying arteriovenous access complications such as infection, steal syndrome, and high-output cardiac failure; and making timely referrals to facilitate arteriovenous access creation and treatment of arteriovenous access complications.

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Section: Arteriovenous Access Complicationsmentioning

confidence: 99%

Arteriovenous Access for Hemodialysis

Lok,

Huber,

Orchanian-Cheff

et al. 2024

JAMA

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“… 2 A steal syndrome associated with dialysis occurs when there is excessive blood flow to a low resistance vascular bed (arteriovenous shunt) and insufficient blood flow to a high resistance vascular bed (distal extremity). 3 This phenomenon can also manifest in AVFs of the lower extremity because many patients with CLTI have poor distal runoff vessels. However, the assessment of peripheral perfusion associated with steal ischaemia has not been established.…”

Section: Introductionmentioning

confidence: 99%