Dialysis shunt-associated steal syndrome (DASS) following brachial accesses: the value of fistula banding under blood flow control

Abstract

Banding under blood flow control resulting in an approximately 50% reduction in the initial blood flow is an adequate therapeutic option in patients with brachial HA and type I-DASS. In type II-DASS, banding does not lead to satisfying results, more complex surgical options might be more successful. Diabetes is associated with poor HA outcome in case of DASS.

Hand Ischemia Associated With Dialysis Vascular Access: An Individualized Access Flow‐based Approach to Therapy

“…Dialysis access‐related steal syndrome may become apparent immediately after surgery or can be delayed for periods of weeks, months, or even years after dialysis‐access creation . Hand ischemia is often mild in DASS cases; however, prolonged severe hypoperfusion can lead to tissue necrosis necessitating amputation of fingers, hand, or even a forearm in approximately 1–4% of patients .…”

Transposition of radial artery for reduction of excessive high-flow in autogenous arm accesses for hemodialysis

“…Reduction of high-flow can be indicated to prevent or to treat local or systemic complications such as hand ischemia and cardiac insufficiency. [1][2][3][4][5] The surgical techniques for flow reduction in elbow fistulas reported to date include banding 6,7 and distalization of the anastomosis, 8,9 also called revision using distal inflow (RUDI). 10 Both techniques have limitations and complications.…”

Intervention for Access-Induced Ischemia: Which Option is the Best?

“…Both classifications also include treatment options according to the different stages of DAIIS. In our clinic we have treated more than 300 patients with DAIIS, leading to several publications (8, 9, 15, 21). According to our results there are four stages of DAIIS, the first being intermittent numbness/coldness of the hand; the second being intermittent pain, ongoing numbness, neurological deficits (but no lesions); the third including permanent pain and small lesions and the fourth presenting with quick development of large lesions/gangrene, pain and/or neurological dysfunctions (Tab.…”

“…However, fistula banding was often ineffective as the fistula flow was either insufficient or still too high postoperatively, leading to ongoing ischemia symptoms or to fistula thrombosis (23). In order to optimize this method, several publications describing the successful use of intraoperative flow measurements have been released (9, 18, 19, 24). Other options to prove a successful treatment are intraoperative duplex ultrasound, measurements of pulsations of the distal artery or Doppler signal.…”

“…I). Several surgical techniques have been described to treat DAIIS, such as fistula banding (9), distal revascularization interval ligation (DRIL) (10), proximalization of the arterial inflow (PAI) (11), revision using distal inflow (RUDI) (12), angioplasty of the artery (13), transposition of the radial artery (14) and others. The aim of this paper was to review publications dealing with dialysis access-induced ischemia in order to present the best therapeutic option in the different types of DAIIS according to the current literature and our own experience as a vascular center.…”