Dialysis shunt-associated steal syndrome with autogenous hemodialysis accesses: proposal for a new classification based on clinical results.
BACKGROUND
Dialysis-associated steal syndrome (DASS) is a multifactorial complication. There are several therapeutic options, although because of the lack of research decisions for certain procedures are often made individually. The aim of this retrospective survey was to propose a new classification for DASS, including therapeutic recommendations, to make standardized procedures easier.


METHODS
A total of 63 patients (2001-2006) treated for DASS following autogenuous hemodialysis access (HA) were included in this survey. In 55 (87%) of these patients, surgery was performed. The courses of disease of the patients were evaluated according to clinical symptoms, HA-specific features, and therapeutic results. Statistical evaluation was performed by SSPS software.


RESULTS
Eight patients with mild symptoms were treated successfully using conservative therapy. In 17 patients with pain during exercise or acute neurologic deficiencies, HA banding led to good results. In the case of acral lesions, however, banding was unsuccessful, although interruption of the retrograde flow was sufficient therapy in 94% of cases. Preservation of the HA was unsuccessful in all patients with extended tissue loss (n = 10). Statistical evaluation showed that tissue loss was generally associated with diabetes (p < 0.001) and peripheral arterial occlusive disease (p = 0.001).


CONCLUSIONS
In addition to steal phenomenon (stage I), which can be treated conservatively, there are three stages of DASS following autogenuous HA that require surgical intervention (stage II, no acral lesions; stage III, small acral lesions; stage IV, extended acral lesions). HA banding leads to good results in stage II; in patients with stage III, interruption of the retrograde flow is indicated. However, in patients with extensive tissue loss (stage IV), closure of the HA should be considered.
Thermann
Florian
F
Department of General, Visceral, and Vascular Surgery, University Hospital Halle-Wittenberg, Ernst Grube Street 40, Halle, Germany. florian.thermann@medizin.uni-halle.de
Wollert
Ulrich
U
Dralle
Henning
H
Brauckhoff
Michael
M
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D006225:Hand / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000145:classification* / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D017534:Radial Artery / Q000503:physiopathology; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome