Steal syndrome strategies to preserve vascular access and extremity

Evaluation of patency following revision technique ofhigh-velocity arteriovenous fistula

“…On the other hand, ligation of the access limits the patient's long-term access options. Therefore, correction of DAIIS must preserve the access and, at the same time, improve peripheral arterial circulation (14).…”

“…Additionally, there are reports that DAIIS healed in 90% to 100% of patients, while only 10% to 40% of the banded accesses remained patent in some studies (16)(17)(18). Mickley (14) reported that low fistula flow rate caused by banding may result in inefficient dialysis therapy or even access thrombosis while DAIIS syndrome disappears. On the other hand, Van Hoek et al (19) reported that ischemic symptoms attenuated and all patients successfully continued their dialysis therapy after banding of hemodialysis access to treat hand ischemia.…”

Distal Revascularization and Interval Ligation “DRIL” Procedure in Steal Syndrome Management in Hemodialysed Patients

“…The decision is dependent upon variable elements, comprising the symptoms severity, patient risk factors, and the potential usefulness of the AVA per se [4]. DRIL operation is deemed nowadays the procedure of preference for maintaining the AVA patency while managing steal symptoms [5,6]. It was declared that DRIL technique is a long lasting intervention for DASS, and multiple series have reported perfect long-term try patency rates approaching 80% at 5 years [4,[7][8][9].…”

Tratamento da síndrome de roubo de fístula arteriovenosa pela técnica de revascularização distal e ligadura arterial: relato de três casos

“…The latter presents a typical clinical picture called steal syndrome, which may result in limb loss in severe cases 4 . The most common treatment is AVF ligation aiming at restoration of distal blood flow 5 . This procedure makes the vascular access unviable, so the surgeon must search for another one, which may be difficult sometimes.…”

“…An alternative, still little used in Brazil, is distal revascularization interval ligation (DRIL) [6][7][8] . This procedure is an alternative to simple ligation that, besides treating the ischemia, preserves the access and assures the continuation of dialysis 5 . In this paper, we report three cases of critical limb ischemia due to steal syndrome, treated by DRIL, and review the literature on the subject.…”