Management of dialysis access-associated steal syndrome: use of intraoperative duplex ultrasound scanning for optimal flow reduction.
Dialysis access-associated steal syndrome (DASS) is an uncommon complication after the creation of an arteriovenous fistula and can cause irreversible ischemic damage in severe cases. Dialysis access-associated steal syndrome has been managed with the surgical reduction of the volume flow in the fistula, but this is associated with a certain incidence of access loss. Several methods are described to achieve the delicate balance between essential flow in the fistula and an adequate limb perfusion pressure. We have developed a new method with duplex ultrasound scanning to quantitate the reduction in volume flow, which will allow effective dialysis and provide adequate limb perfusion. The preoperative assessment was reproduced on the operating table with intraoperative duplex scanning. A 65-year-old woman who underwent this treatment has had resolution of her ischemic symptoms and maintains long-term patency of her dialysis access.
Department of Surgery B', Vascular Surgery Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
D
D
Shemesh
N J
NJ
Mabjeesh
H B
HB
Abramowitz
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007430:Intraoperative Care; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy; D011138:Polytetrafluoroethylene; D012039:Regional Blood Flow; D006435:Renal Dialysis; D018616:Ultrasonography, Doppler, Duplex
D011138:Polytetrafluoroethylene