Short interposition grafting for dialysis-access steal syndrome treatment

Papadoulas, Spyros; Mulita, Francesk; Theodoropoulou, Theoni; Dousdampanis, Periklis

doi:10.1136/bcr-2021-248446

Cited by 2 publications

(1 citation statement)

References 7 publications

(16 reference statements)

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“…2) Various surgical options for the treatment of DASS have been advocated. Banding or plication, 3) revision using distal inflow (RUDI), 4) and short graft interposition 5) are usually suggested for DASS associated with high-flow arteriovenous fistulas (AVFs); meanwhile, distal revascularization and interval ligation (DRIL) 6) and proximalization of arterial inflow 7) are suggested for DASS in normal-and low-flow AVFs. [8][9][10] RUDI involves distalization of the original AVF to the proximal radial or ulnar artery in the forearm using a native vein or synthetic graft, so that a separate artery is preserved for blood flow to the hand, hence relieving the steal symptoms.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Revision Using Distal Inflow in Patients with Symptomatic Dialysis Access-Associated Steal Syndrome

Usman,

Jamil,

Fatima

et al. 2023

Annals of Vascular Diseases

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Objectives: In this study, we aim to assess the efficacy of revision using distal inflow (RUDI) in patients with symptomatic dialysis access-associated steal syndrome (DASS). Materials and Methods: All consecutive patients who were diagnosed with grade 3 or 4 DASS and have undergone RUDI in 4 years were included in this study. Results: In total, 35 patients were included in this study; participants had a mean age of 47.5±7.52 years and 54% (n=19) were males. As per our findings, significant improvement was noted in terms of paresthesia (81.2%, p-value: 0.012), coolness (79.4%, p-value: 0.006), pain (78.1%, p-value: 0.006), discoloration (76.4%, p-value: 0.044), paresis (71.4%, p-value: 0.016), and ulcer healing (50%, p-value: 0.044). Gangrene did not further progress in all patients (n=35). Reduction in fistula flow rate after RUDI was 57.5% (682±121 ml/min, p-value: 0.001). Digital systolic pressure was noted to improve by 71.4% (60±9.2 mmHg, p-value: 0.002) after RUDI. Peak systolic velocity increased in both ulnar (66.1±8.2 cm/s, p-value: 0.04) and radial (64.2±7.6 cm/s, p-value: 0.024) arteries of the wrist. Cumulative patency of RUDI graft was 100%, 91.4%, and 85.7% at 3, 6, and 12 months, respectively. Conclusion: RUDI has resulted in significant improvements in terms of DASS symptoms. Using a native vein as conduit, RUDI should be considered a procedure of choice for patients with high-flow DASS.

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Section: Introductionmentioning

confidence: 99%

Efficacy of Revision Using Distal Inflow in Patients with Symptomatic Dialysis Access-Associated Steal Syndrome

Usman,

Jamil,

Fatima

et al. 2023

Annals of Vascular Diseases

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Novel Endovascular Techniques for Dialysis Access-Associated Steal Syndrome (DASS)

AlShammeri,

AlEidan,

Budaichieva

et al. 2023

Dr. Sulaiman Al Habib Med J

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End-stage renal disease patients with arteriovenous fistula (AVF) encounter many vascular risks related to reduced or increased arteriovenous fistula flow. Dialysis access-associated steal syndrome is one of the devastating complications that may lead to limb loss. Multiple vascular techniques (surgical and endovascular) can be used to correct this complication. In this article, we present two endovascular approaches. One approach uses a stent graft covering two thirds of anastomosis for arteriovenous fistulas to generate artificial stenosis and divert more flow to the hand. The other approach applies Supera® stent jailing to the arteriovenous fistula to divert more flow to the hand. Over 12 months of follow up, there was no clinical manifestation of dialysis access-associated steal syndrome and the AV fistula continued to function.

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Short interposition grafting for dialysis-access steal syndrome treatment

Cited by 2 publications

References 7 publications

Efficacy of Revision Using Distal Inflow in Patients with Symptomatic Dialysis Access-Associated Steal Syndrome

Efficacy of Revision Using Distal Inflow in Patients with Symptomatic Dialysis Access-Associated Steal Syndrome

Novel Endovascular Techniques for Dialysis Access-Associated Steal Syndrome (DASS)

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