Steal in hemodialysis patients depends on type of vascular access.
OBJECTIVE
To study incidence and severity of steal phenomena in hemodialysis patients and to investigate possible methods for its detection.


METHODS
A questionnaire was composed based on a literature search. A subgroup of patients having steal as identified by the questionnaire was studied using physical examination, arterial blood pressure, skin temperature, digital oxygenation, grip strength and plethysmography. Contralateral arms served as controls.


RESULTS
A cold hand was present in 50% of the patients with a brachiocephalic (BC) arteriovenous fistula (AVF, n = 28) compared to 25% of prosthetic forearm loops (loop, n = 27) and 12% of the radiocephalic (RC, n = 65, p < 0.05) fistulas. Diabetics were at risk for steal (p < 0.001). Intensity of steal was not related to magnitude of access flow. Digital skin temperatures and grip strength were lower in steal hands (p < 0.02). Manual compression of the AVF normalised low digital pressures in steal hands (106 +/- 33 vs 154 +/- 25 mmHg, p < 0.001, contralateral side 155 +/- 21 mmHg).


CONCLUSIONS
Mild to moderate steal symptoms are common in a hemodialysis patient. Individuals with a BC are at a higher risk for developing complaints associated with reduced hand circulation compared to patients with a RC or loop. Low finger pressures in the presence of steal symptoms are usually reversible.
van Hoek
F
F
Department of Surgery, Maxima Medical Center (MMC), Veldhoven, The Netherlands.
Scheltinga
M R
MR
Kouwenberg
I
I
Moret
K E M
KE
Beerenhout
C H
CH
Tordoir
J H M
JH
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D001916:Brachial Artery / Q000503:physiopathology; D048909:Diabetes Complications / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005385:Fingers / Q000098:blood supply; D006225:Hand / Q000098:blood supply*; D018737:Hand Strength; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008297:Male; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D017156:Photoplethysmography; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012881:Skin Temperature; D011795:Surveys and Questionnaires