Dialysis shunt-associated steal syndrome (DASS) following brachial accesses: the value of fistula banding under blood flow control.
BACKGROUND
Dialysis shunt-associated steal syndrome (DASS) is a rare complication of hemodialysis access (HA) which preferably occurs in brachial fistulas. Treatment options are discussed controversially. Aim of this study was to evaluate flow-controlled fistula banding.


METHODS
Patients treated between 2002 and 2006 were included in this prospective survey. According to a classification we established, patients were typed DASS I-III (I: short history, no dermal lesions; II: long history, skin lesions; III: long history, gangrene). Surgical therapy was HA banding including controlled reduction (about 50% of initial flow) of HA blood flow (patients type I and II). Patients with type III underwent closure of the HA.


RESULTS
In 15 patients with relevant DASS, blood-flow-controlled banding was performed. In ten patients (all type I), banding led to restitution of the hand function while preserving the HA. In five patients (all type II), banding was not successful; in two patients, closure of the HA was performed eventually. In five patients (type III), primary closure of the HA was performed. Four patients with DASS type II but only two with DASS type I had diabetes mellitus (p = 0.006).


CONCLUSIONS
Banding under blood flow control resulting in an approximately 50% reduction in the initial blood flow is an adequate therapeutic option in patients with brachial HA and type I-DASS. In type II-DASS, banding does not lead to satisfying results, more complex surgical options might be more successful. Diabetes is associated with poor HA outcome in case of DASS.
Thermann
Florian
F
Department of General, Visceral and Vascular Surgery, University Hospital Halle/Saale, Ernst-Grube-Strasse 40, 06097 Halle, Germany. florian.thermann@medizin.uni-halle.de
Ukkat
Jörg
J
Wollert
Ulrich
U
Dralle
Henning
H
Brauckhoff
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D000772:Anesthesia, Local; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity / Q000502:physiology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D006435:Renal Dialysis; D012086:Reoperation; D018616:Ultrasonography, Doppler, Duplex