Predictors of steal syndrome in hemodialysis patients

Abstract

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.

Basilic vein transposition for unsuitable upper arm hemodialysis needle access segment may attenuate concurrent hand ischemia

“…Intuitively one might speculate that a dual outflow tract of both a cephalic and a basilic vein as in Gracz‐AVF leads to a higher risk of hand ischemia. In one retrospective study on brachial artery‐based AVFs, 65% of patients that developed hand ischemia harbored a Gracz‐type fistula compared to 41% of patients without ischemic complaints . Interestingly, in one study on SB ligation, isolated ligation of the basilic vein sufficiently increased intraoperative DBI in only one patient whereas ligation of additional SBs was required in four patients .…”

Comparison of standard forearm prosthetic loop grafts to composite semiloop forearm grafts (“semi‐grafts”) in hemodialysis patients: A prospective study

“…Due to the risk of sepsis, graft explantation was performed. Only two patients developed steal syndrome in this study (LG‐group), both classified as stage 1, and not requiring intervention.…”

Access-related hand ischemia and the Hemodialysis Fistula Maturation Study

“…5, 8, 13-16 Rocha et al 26 reported that female gender, diabetes, and side-to side anastomoses were predictors in their multivariate model with diabetes being the strongest predictor (OR 3.08, CI 1.2 – 8.2). The presence of coronary artery disease has been an inconsistent predictor of ARHI in contrast to our finding.…”