[Fistula Banding - Success-promoting Approach in Peripheral Steal Syndrome].
OBJECTIVE
Evaluation of the diagnostic and therapeutic management of peripheral steal syndrome after placement of an autologous arteriovenous (av-) fistula and presentation of treatment results after its surgical correction.


METHODS
During a time period from 1994 to 1999, 1 253 av-fistulas for hemodialysis were placed in our surgical department. Twenty-one patients (1.68 %) underwent service operations because of considerable lower perfusion of the hand. In 14 patients the av-fistula was ligated, whereas in 7 patients, a polytetrafluorethylene (PTFE) sleeve was implanted at the venous site for fistula "banding" to diminish blood flow. In addition to the clinical finding, pre-, intra- and postoperative blood flow rates were determined using Duplex ultrasonography.


RESULTS
In patients showing flow rates of < 250 ml (carefully disclosed empiric value) ligation was chosen, whereas in cases with distinctly increased flow rates, banding of the arterialized vein was performed (authors' individually selected borderline flow). The extension of the banding was specified according to the intraoperatively determined flow rates. Recurrent steal syndrome was not observed over the entire postoperative observation period of 1-3 years.


CONCLUSIONS
Arterial steal syndrome is a rare complication after placement of an av-fistula. In the majority of cases, surgical therapy is necessary. Pre- and intraoperative analysis of flow rates using Duplex ultrasonography may help to select the appropriate surgical approach and may, thus, determine the success rate of service operation.
Klinik für Chirurgie, Universitätsklinikum, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Germany.
F
F
Meyer
J S
JS
Müller
R
R
Grote
Z
Z
Halloul
H
H
Lippert
T
T
Bürger
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity / Q000502:physiology; D015331:Cohort Studies; D004550:Elbow / Q000098:blood supply; D005260:Female; D005542:Forearm / Q000098:blood supply; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler
D011138:Polytetrafluoroethylene