title: Steal syndrome complicating hemodialysis access procedures: can it be predicted?
abstract: The development of steal syndrome distal to an arteriovenous fistula (AVF) created for hemodialysis access remains a significant clinical problem. This study was undertaken to determine the role of intraoperative noninvasive testing in the prediction and management of steal syndrome following arteriovenous fistula creation. First, in order to determine a threshold digital/brachial index (DBI) for patients at risk for steal syndrome, we performed a retrospective review of patients who had had the DBI measured and who developed symptoms (steal syndrome) following AVF creation. This was followed by a prospective evaluation of the ability of the DBI to predict which patients undergoing AVF surgery would develop steal syndrome. A DBI of <0.6 identifies a patient at risk for steal syndrome. Intraoperative DBI cannot be used to predict which patient will develop steal syndrome; however, if revision is indicated, the DBI should be increased to >0.6. Failure to accomplish this puts the patient at risk for continued steal syndrome.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23510, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Goff
authors.forename: D T
authors.initials: DT
authors.lastname: Sato
authors.forename: P H
authors.initials: PH
authors.lastname: Bloch
authors.forename: R J
authors.initials: RJ
authors.lastname: DeMasi
authors.forename: R T
authors.initials: RT
authors.lastname: Gregory
authors.forename: R G
authors.initials: RG
authors.lastname: Gayle
authors.forename: F N
authors.initials: FN
authors.lastname: Parent
authors.forename: G H
authors.initials: GH
authors.lastname: Meier
authors.forename: J R
authors.initials: JR
authors.lastname: Wheeler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001916:Brachial Artery / Q000502:physiology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors