Revision Using Distal Inflow: A Novel Approach to Dialysis-associated Steal Syndrome

Minion, David J.; Moore, E. Whitney G.; Endean, Eric D.

doi:10.1007/s10016-005-5827-7

Cited by 144 publications

(113 citation statements)

References 7 publications

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“…3,4,8,13,14 These factors presumably relate to increased or more diffuse arteriosclerosis of the arteries in the forearm and hand, and poor development of collaterals.…”

Section: Pathophysiology Of the Ischemic Steal Syndromementioning

confidence: 99%

Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis

2009

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Arteriovenous fistulae in the arm are commonly used for hemodialysis in end-stage renal disease. Although physiological steal with reverse flow in the artery distal to the fistula is common, hand ischemia or infarction are rare. The ischemic steal syndrome (hand or forearm ischemia) is usually a result of arterial disease proximal or distal to the fistula and/or poor collateral supply to the hand. The diagnosis is primarily clinical; however, markedly reduced digital pressures and pulse volume recordings support the diagnosis. Management requires imaging for focal stenoses or disease in arteries proximal and distal to the fistula from the aorta to the hand. We present a case caused by subclavian artery occlusion that was initially missed due to focusing investigation only on the fistula. We describe the percutaneous treatments and surgical revisions that attempt to restore flow to the hand without compromising the fistula.

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“…3,4,8,13,14 These factors presumably relate to increased or more diffuse arteriosclerosis of the arteries in the forearm and hand, and poor development of collaterals.…”

Section: Pathophysiology Of the Ischemic Steal Syndromementioning

confidence: 99%

Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis

2009

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“…It is an extensive procedure, and ligation of the brachial artery and leaving arterial supply of the hand dependent on a bypass graft has been a concern. To address this issue, an alternative procedure was recently reported, the RUDI (50). Instead of the brachial artery, the fistula is ligated at its origin.…”

Section: Surgical Interventionsmentioning

confidence: 99%

Arteriovenous Access and Hand Pain

León

Asif

2007

Clinical Journal of the American Society of Nephrology

125

104

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An ischemic hand in a hemodialysis patient is a serious condition. It causes significant pain and discomfort but also can lead to tissue necrosis and the eventual loss of digits and even the entire hand. Although stealing of blood away from the high-resistance forearm arteries into the low-resistance arteriovenous access generally is assumed to be the cause, a great majority of both wrist and elbow accesses demonstrate retrograde flow without any evidence of hand pain or ischemia. Consequently, demonstration of retrograde flow alone does not predict or indicate the existence of distal ischemia. In this context, the term "arterial steal syndrome" is a misnomer to indicate the presence of peripheral ischemia. Recent studies have shown that, in many cases, arterial stenotic lesions cause distal hypoperfusion and result in hand ischemia. In other cases, distal arteriopathy as a result of generalized vascular calcification and diabetes is the culprit. Because any or a combination of the three mechanisms (retrograde flow, stenotic lesions, and distal arteriopathy) can lead to peripheral ischemia, distal hypoperfusion ischemic syndrome is a more appropriate term to denote hand ischemia. Treatment should start with a detailed history and physical examination to help rule out other (nonischemic) causes of hand pain. A complete arteriogram to evaluate the circulation of the extremity from the aortic arch to the palmar arch is essential. The choice of treatment modality and procedure to apply should be based on this evaluation. This report reviews the pathophysiology and presents current strategies to ameliorate distal hypoperfusion ischemic syndrome.

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“…Many other surgical options have been described. The revision using distal inflow procedure (RUDI) was described by Minion et al 19 In the RUDI, the dialysis access is ligated proximally just after the arterial anastomosis. A bypass graft is created from a smaller more distal artery such as a radial or ulnar to the dialysis access (Fig.…”

Section: Additional Treatment Optionsmentioning

confidence: 99%

“…This anatomy leaves the perfusion to the forearm and hand intact and only potentially places the dialysis access at risk if the bypass occludes. 1,12,19 Proximalization of the arterial inflow is another procedure that has been described, which is performed by moving the arterial anastomosis proximally from the brachial artery to the axillary artery by using a bypass graft. 12,20,21 The more proximal arterial anastomosis should increase the flow to the forearm by increasing pressure at the split point between the arm and the dialysis access.…”

Section: Additional Treatment Optionsmentioning

confidence: 99%

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

Regalado

Navuluri²,

Vikingstad³

2009

Semin intervent Radiol

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Dialysis-associated steal syndrome is a clinically significant complication associated with the creation of dialysis grafts or fistulae. The distal revascularization and interval ligation (DRIL) procedure is a surgical procedure, which has been used to treat patients with hand ischemia secondary to arterial ''steal'' from dialysis accesses. This article will review the dialysis-associated steal syndrome and the history, anatomy, and clinical results of the DRIL procedure.

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Revision Using Distal Inflow: A Novel Approach to Dialysis-associated Steal Syndrome

Cited by 144 publications

References 7 publications

Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis

Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis

Arteriovenous Access and Hand Pain

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

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