Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Regalado, Sidney; Navuluri, Rakesh; Vikingstad, Eric M.

doi:10.1055/s-0029-1222456

Cited by 11 publications

(11 citation statements)

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“…Our rate (8%) of steal syndrome was higher than the 3%–6% cited by Kariya and Scheltinga, but close to that reported by other authors …”

Section: Discussionsupporting

confidence: 87%

“…Our rate (8%) of steal syndrome was higher than the 3%-6% cited by Kariya 1 and Scheltinga, 8 but close to that reported by other authors. 9,10 Epidemiologic studies have established that chronic kidney disease is a risk factor for PAD. O'Hare et al, analyzing the National Health and Nutrition Examination Survey 1999-2000, concluded that there is a high prevalence of PAD in adults with chronic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of steal syndrome in hemodialysis patients

Rocha

Silva

Queirós

et al. 2012

Hemodialysis International

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Steal syndrome is a feared complication of dialysis vascular access in a population becoming older and frailer. The aim of this study was to determine the predictor factors of steal syndrome. All proximal arteriovenous fistulas (AVFs), patent at day 30, inserted between January 2008 and December 2009 were studied. Data on age, gender, diabetes mellitus (DM) status, presence of coronary or peripheral artery disease, date of initiation of renal replacement therapy, date of access construction, localization, type of anastomosis, previous interventions, and outcome for AVF and patients were analyzed. There were 324 AVFs placed into 309 individual patients. The mean age was 66.7 ± 15.3 years, and the majority (53.7%) of the patients was male. Mean follow-up of all 324 fistulas was 18.6 ± 8.5 months. During follow-up, steal syndrome occurred in 26 (8%) of the AVFs. Univariate analysis revealed correlations between steal syndrome and DM (P = 0.002), brachiomedian fistulas (P = 0.016), and side-to-side (STS) anastomosis (P = 0.003). However, in multivariate analysis, the presence of DM, STS anastomosis, and female gender were found to be the independent risk factors. The strongest predictive factor was DM (odds ratio: 6.7; 95% confidence interval: 2.5-17.9). Being diabetic is the factor most predictive of having steal syndrome. In diabetic women, with a proximal access, it seems preferable to construct fistulas with end-to-side anastomosis to minimize the risk.

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“…Our rate (8%) of steal syndrome was higher than the 3%–6% cited by Kariya and Scheltinga, but close to that reported by other authors …”

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Predictors of steal syndrome in hemodialysis patients

Rocha

Silva

Queirós

et al. 2012

Hemodialysis International

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“…In milder cases, we monitor the development of symptoms, and a radical approach is not required. Percutaneous transluminal angioplasty with possible stent implantation in the case of a stenotic lesion is carried out as a part of diagnostic arteriography and may be a therapeutic option for a third of cases [ 40 , 45 ].…”

Section: Complications During and Immediately After Surgical Intervenmentioning

confidence: 99%

Most Important Chronic Complications of Arteriovenous Fistulas for Hemodialysis

Stolić¹

2012

Med Princ Pract

142

107

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The aim of this review was to highlight the most important complications of arteriovenous fistulas (AVFs) for hemodialysis (HD). The quality of vascular access for HD should be suitable for repeated puncture and allow a high blood flow rate for high-efficiency dialysis with minimal complications. The dialysis staff must be well versed in manipulation of the AVF, and there should be a minimal need for corrective interventions. Construction of an AVF creates conditions for increasing the flow of blood through the venous system. Fulfillment of these conditions reduces the risk of turbulence and endothelium injury, which, in turn, minimizes the potential for stenosis. An AVF is closest to the ideal model of vascular access. The most important complications of fistulae for HD are lymphedema, infection, aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy and thrombosis. In HD patients, the most common cause of vascular access failure is neointimal hyperplasia. It is important to gain information about early clinical symptoms of AVF dysfunction in order to prevent and adequately treat potential complications.

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“…On the other hand, atherosclerotic disease, caused by insufficient collateral perfusion, reduce the flow through the AVF in our patients with DHIS. Because, in the literature is known, that the low vascular resistance in fistulated veins, and arterial stenosis, in the proximal parts, encourages arm ischemia, and reduces blood flow in distal parts of the vascular bed [12][13][14] . An AVF can cause significant local and general changes in the bloodstream.…”

Section: Hemodynamic Impact On the Development Of Distal Ischemiamentioning

confidence: 99%

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Stolić¹

2013

WJN

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AIM:To determine survival parameters as well as characteristics of patients with this syndrome. METHODS:The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died. RESULTS:Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). KaplanMeier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e. , patients with confirmed digital hypoperfusion ischemic syndrome died earlier. CONCLUSION:Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.© 2013 Baishideng. All rights reserved.Key words: Digital hypoperfusion ischemic syndrome; Predictive parameters; Survival; Arteriovenous fistula; Hemodialysis Core tip: In order to prevent the occurrence of distal hypoperfusion syndrome, is important identification of risk factors. Problem is the absence of objective indicators of distal ischemia, which is main reason why large proportion our patients have of this symptoms. Our patients with these symptoms were significantly older, which confirms older age as a factor that characterizes BRIEF ARTICLE 26May 6, 2013|Volume 2|Issue 2| WJN|www.wjgnet.com patients with distal hypoperfusion syndrome. We have confirmed greater incidence of diabetes mellitus and smokers among the patients with distal hypoperfusion syndrome. Quality of dialysis, diabetes mellitus, erythropoietin therapy, smokers and hemodiafiltration has predictive value for survival of patients with distal ischemia.Stolic RV, Trajkovic GZ, Miric DJ, Kisic B, Djordjevic Z, Azanjac GL, Stanojevic MS, Stolic DZ. Arteriovenous fistulas and digital hypoperfusion ischemic ...

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Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Cited by 11 publications

References 20 publications

Predictors of steal syndrome in hemodialysis patients

Predictors of steal syndrome in hemodialysis patients

Most Important Chronic Complications of Arteriovenous Fistulas for Hemodialysis

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

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