title: Treatment of vascular access-related steal syndrome by means of juxta-anastomotic vein interposition of a prosthetic graft segment.
abstract: OBJECTIVE
  Steal syndrome is a severe complication of vascular access. Our aim is to present the initial results of a simple and effective treatment: the interposition of a prosthetic segment in the juxta-anastomotic vein.
  
  
  METHODS
  Between 2009 and 2012, 14 patients (57 % male, average age 71) with severe steal syndrome due to vascular access (stages II-IV), following a clinical and systematic echographic study and a selective angiographic study, were treated through the interposition of a 6 mm segment of PTFE in the juxta-anastomotic vein, in addition to selective patch repair of arterial stenosis (2 cases) or ligature of useless venous collaterals (8 cases). Local or regional anaesthesia was used and outpatient care was given in all cases.
  
  
  RESULTS
  There was 100 % technical success. The pre- and post-operative echographical study showed a reduction of post-operative access flow by 39 % and an increase of radial artery flow by 477 %. Ischaemic symptoms were resolved in 12 patients (86 %); the other two patients required additional procedures due to persistent ischaemic symptoms. There was a post-operative venous rupture, which required a definitive ligation. No patient suffered amputations, nor were there losses or access thrombosis during the follow-up. The primary and primary-assisted patencies free of new ischemic symptoms were 78 % and 78 % at 12 months, and 62 % and 78 % at 24 months.
  
  
  CONCLUSIONS
  The interposition of a prosthetic segment in the juxta-anastomotic vein is a simple, quick and effective technique in the treatment of vascular steal syndrome, with promising results at the 2 year follow-up.
authors.forename: Gaspar
authors.initials: G
authors.lastname: Mestres
authors.forename: Néstor
authors.initials: N
authors.lastname: Fontseré
authors.forename: Ramón
authors.initials: R
authors.lastname: Bofill
authors.forename: César
authors.initials: C
authors.lastname: García-Madrid
authors.forename: Nicolás
authors.initials: N
authors.lastname: García-Ortega
authors.forename: Fredy
authors.initials: F
authors.lastname: Rojas
authors.forename: Marta
authors.initials: M
authors.lastname: Barrufet
authors.forename: Vicente
authors.initials: V
authors.lastname: Riambau
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013577:Syndrome; D062666:Vascular Access Devices / Q000009:adverse effects*; D014652:Vascular Diseases / Q000209:etiology* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins / Q000601:surgery