Treatment of dialysis access-associated steal syndrome with the "revision using distal inflow" technique.
OBJECTIVE
Dialysis access-associated steal syndrome (DASS) is a common, serious complication of antecubital fossa (ACF) arteriovenous fistulas (AVFs). We describe our experience of the "revision using distal inflow" (RUDI) technique for the treatment of DASS and review the literature.


METHODS
Patients underwent fistula ligation at the anastomosis with re-establishment of inflow via the proximal radial or ulnar arteries using a venous interposition graft or venous collateral. A retrospective analysis of outcomes of all patients undergoing this procedure at our center was carried out.


RESULTS
Seven patients with autogenous ACF AVFs underwent the RUDI procedure, four under local anesthesia. Interposition vein grafts were used in five patients, and inflow was achieved through the proximal radial artery in four cases. The median post-operative rise in digital systolic blood pressure was 65.5 mmHg. Follow-up at 7-36 months found that three fistulas had failed (one at 8 months, two within days), two patients had died with patent fistulas, one patient was transplanted with a functional AVF, and the remaining patient continues to dialyze through the fistula. No patients developed DASS post-operatively and no further interventions were required to maintain patency.


CONCLUSIONS
Although RUDI was successful at treating DASS, a high rate of AVF failure was seen. With technical modifications and further experience, RUDI may become a valuable tool in the surgical armamentarium.
University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK. cjc74@cam.ac.uk
Chris J
CJ
Callaghan
Mekhola
M
Mallik
Rajesh
R
Sivaprakasam
Satheesh
S
Iype
Gavin J
GJ
Pettigrew
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D003097:Collateral Circulation; D004739:England; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000503:physiopathology / Q000601:surgery*; D058017:Vascular Grafting; D014680:Veins / Q000503:physiopathology / Q000601:surgery