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Vascular access steal syndrome

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In nephrology, vascular access steal syndrome or dialysis-associated steal syndrome (DASS) is a syndrome caused by ischemia (not enough blood flow) resulting from a vascular access device (such as an arteriovenous fistula or synthetic vascular graft–AV fistula) that was installed to provide access for the inflow and outflow of blood during hemodialysis.

Contents

Signs

  • Pallor
  • Diminished pulses (distal to the fistula)
  • Necrosis
  • Decreased wrist-brachial index (ratio of blood pressure measured in the wrist and the blood pressure measured in the upper arm), especially if below 0.6

    • Symptoms

  • Pain distal to the fistula.

    • Incidence

    DASS occurs in about 1% of AV fistulas and 2.7-8% of PTFE grafts.

    Investigations

  • Arteriography

    • Treatment

    The fistula flow can be restricted through banding, or modulated through surgical revision.

    Revascularization techniques

  • DRIL (Distal Revascularisation and Interval Ligation) procedure
  • PAI (Proximalization of the Arterial Inflow)
  • RUDI (Revision Using Distal Inflow)

    • Banding techniques

  • Narrowing suture
  • Plication
  • Minimally invasive MILLER banding
  • Tapering
  • Surgical banding

    • If the above methods fail, the fistula is ligated, and a new fistula is created in a more proximal location in the same limb, or in the contralateral limb.

    Names

    Within the contexts of nephrology and dialysis, vascular access steal syndrome is also less precisely just called steal syndrome (for short), but in wider contexts that term is ambiguous because it can refer to other steal syndromes, such as subclavian steal syndrome or coronary steal syndrome.

    References

    Vascular access steal syndrome Wikipedia
    (Text) CC BY-SA


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