Understanding strategies for the treatment of ischemic steal syndrome after hemodialysis access1

Wixon, Christopher L.; Hughes, John D.; Mills, Joseph L.

doi:10.1016/s1072-7515(00)00335-5

Cited by 142 publications

(132 citation statements)

References 16 publications

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“…Commonly encountered symptoms include cold hand, numbness, and hand pain on and/or off dialysis. Lowering of BP and provocation of peripheral vasoconstriction might explain the development of pain during dialysis (22). Advanced cases reveal trophic changes that are characterized by the development of ischemic ulcers and dry gangrene of one or more digits.…”

Section: Clinical Features and Differential Diagnosismentioning

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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Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

Arteriovenous Access and Hand Pain

León

Asif

2007

Clinical Journal of the American Society of Nephrology

125

104

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“…However, some authors do not agree 29 . Other risk factors include the use of brachial artery 30,31 , age over 60 30 , female gender 26, 31 and lupus 26 . In terms of the steal syndrome occurrence, the brachiocephalic fi stula is a risk factor as opposed to the radiocephalic fi stula or to the application of the loop using a vascular prosthesis 24 .…”

Section: Resultsmentioning

confidence: 99%

“…The physiological steal is a demonstrable drop in blood pressure at the periphery and is compensated by the arterial collateral circulation and vasodilation. If these mechanisms fail, the symptomatic form occurs in 3.7-8 % of the fi stulas 14,19,25,30,34 . In the brachiocephalic and brachiobasilic fi stulas it even appears in as much as 10-25 % 19 .…”

Section: Resultsmentioning

confidence: 99%

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Bachleda¹,

Utíkal²,

Kojecký³

et al. 2007

BIOMED PAP

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Background:The autogenous brachiocefalic or brachiobasilic arteriovenous elbow fi stula is not considered to be only the secondary haemodialysis access. In patients with an unsuitable forearm vessel bundle, it is indicated as primary access and it is the method preferred to the fi stula creation using a vascular prosthesis. Its rather rare complication is the development of upper extremity ischemia.Aim: To summarise current knowledge of this fi stula type and its associated complications Methods: Review of the literature. Results:The creation and maturation of the fi stula and occurrence of the steal syndrome is infl uenced by a number of factors. The analysis and awareness of such factors will provide for creation of a suitable fi stula as well as for timely complication diagnostics and treatment.Conclusions: The autogenous elbow fi stula utilising the brachial artery and the cephalic or basilic vein in the upper extremity represents a high-quality haemodialysis access. Its potential complication is the occurrence of the steal syndrome. Its occurrence and manifestations do not constitute indications for ligation of the access. The gathered information shows that a suitable surgical procedure can help meet the basic rule for haemodialysis access -resolving the ischemia and maintaining the access.

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“…Doppler ultrasonography is able to identify the cause of ischemia by showing flow inversion in the brachial artery distal to the anastomosis, and reduced flow in the distal arteries of the forearm. It is important for surgical planning to show the distal arterial outflow and the assessment of palmar arch patency [16][17][18] . Many techniques for the treatment of ischemic syndrome in patients with upper fistulas have been described, and they aim to decrease the AVF flow, thus improving distal ischemia and decreasing flow inversion in the distal artery 8,[19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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Fístulas arteriovenosas para hemodiálise podem apresentar complicações a longo prazo. Entre as complicações mais raras, há a isquemia distal por síndrome de roubo. Os autores relataram a experiência de três casos de pacientes portadores de fístulas braquiocefálicas, em funcionamento por longo prazo e que evoluíram com isquemia crítica do membro, sem resposta com tratamento clínico. Com o intuito de tratar esta afecção e preservar o acesso vascular, optou-se pela realização da revascularização distal interposta por ligadura arterial. Devido à raridade dos casos, relatou-se a experiência e apresentou-se uma revisão de literatura.

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Understanding strategies for the treatment of ischemic steal syndrome after hemodialysis access1

Cited by 142 publications

References 16 publications

Arteriovenous Access and Hand Pain

Arteriovenous Access and Hand Pain

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

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

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