Steal syndrome complicating upper extremity hemoaccess procedures: incidence and risk factors.
BACKGROUND
Steal syndrome is a potentially grave complication of upper extremity hemoaccess (HA) in patients with renal failure. To determine the incidence and risk factors for steal in these patients at the St. Boniface Hospital, Winnipeg, a tertiary care centre for vascular surgery and dialysis, we reviewed data from patients requiring hemodialysis between September 1986 and July 2000.


METHODS
We excluded all venous catheter and lower extremity procedures. There remained 325 upper extremity procedures in 217 patients. Data were collected from the patients' charts or by interview. First by univariate analysis and then by multivariate analysis for independent risk factors, we studied the effect on the development of steal of age, sex, race diabetes mellitus, hypertension, coronary artery disease or cerebrovascular disease, smoking, proximal procedures based on the brachial artery, distal procedures based on the radial artery, the use of prosthetic graft material and the creation of autologous fistulas.


RESULTS
The incidence of steal was 6.2%. The significant independent risk factors were diabetes mellitus (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.39-18.08, p = 0.01) and Aboriginal race (OR 3.59, 95% CI 1.07-12.04, p = 0.04). An increasing risk for each year of advancing age at the time of procedure was suggested but was not significant (OR 1.04, 95% CI 1.00-1.09 p = 0.07).


CONCLUSIONS
Patients who are diabetic or Aboriginal are at increased risk for steal with upper extremity HA procedures. This knowledge can guide discussion of dialysis options and informed consent. If upper extremity HA procedures are undertaken in patients at risk, they should be closely monitored and early intervention applied if necessary.
Davidson
Dion
D
Division of Vascular Surgery, Department of Surgery, St. Boniface Hospital and University of Manitoba, Winnipeg, Man. diondavidson@hotmail.com
Louridas
George
G
Guzman
Randolph
R
Tanner
John
J
Weighell
Wendy
W
Spelay
Jodi
J
Chateau
Dan
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data; D007258:Informed Consent; D016015:Logistic Models; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors; D013349:Subclavian Steal Syndrome / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D034941:Upper Extremity / Q000098:blood supply*