Distalization of the anastomosis: an effective treatment for dialysis access-associated steal syndrome.
Steal syndrome after arteriovenous fistula formation for dialysis access can cause ischemic pain and tissue loss. This is an indication for surgical revision, usually either banding (or ligation) or the distal revascularisation and interval ligation procedure. However, banding is inexact, and distal revascularisation and interval ligation can further compromise the arterial supply to the arm. We report three cases in which an alternative approach of moving the arteriovenous anastomosis distally was used, thereby protecting arterial inflow to the hand. In all three cases, the steal resolved and the fistula remained patent.
Department of Vascular Surgery, Fremantle Hospital, Perth, Western Australia. lcorfield@doctors.org.uk
Lorraine
L
Corfield
Juanita
J
Muller
Jo
J
Ryan
Rick
R
Bond
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods*