Document Detail


Arterial pressure gradient of upper extremity arteriovenous access steal syndrome: treatment implications.
MedLine Citation:
PMID:  20675320     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Treatment options after arteriovenous fistula (AVF) associated steal include ligation, banding, and distal revascularization-interval ligation (DRIL). The purpose of this study was to evaluate the arterial pressure gradients in upper extremity steal syndrome.
METHODS: Preoperative arteriography and sequential intra-arterial pressure readings were performed on consecutive AVF patients with hand ischemia. Analysis of variance (ANOVA) with repeated measures analyzed intersubject comparisons, and post hoc analysis identified anatomic locations with highest inflow pressures.
RESULTS: Nine patients presented with ischemic hand symptoms after AVF. Pullback arterial pressure measurements revealed gradual increases in systolic and mean pressures as the catheter position was moved proximally from the AVF anastomosis. Post hoc analysis after ANOVA revealed higher axillary artery systolic pressure compared to proximal brachial artery (153 vs 116.8, P = .007).
CONCLUSION: AVF-related steal syndrome decreases arterial inflow pressure of the affected extremity more proximally than previously thought. When performing a DRIL procedure, consideration should be given to placing the anastomosis as proximally as possible.
Authors:
Thomas Reifsnyder; George J Arnaoutakis
Publication Detail:
Type:  Journal Article     Date:  2010-07-30
Journal Detail:
Title:  Vascular and endovascular surgery     Volume:  44     ISSN:  1938-9116     ISO Abbreviation:  Vasc Endovascular Surg     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-18     Completed Date:  2011-02-02     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  101136421     Medline TA:  Vasc Endovascular Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  650-3     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Arteriovenous Shunt, Surgical / adverse effects*
Axillary Artery / physiopathology,  surgery*
Baltimore
Blood Pressure*
Brachial Artery / physiopathology,  surgery*
Humans
Ischemia / etiology,  physiopathology,  radiography,  surgery*
Ligation
Middle Aged
Prospective Studies
Regional Blood Flow
Renal Dialysis*
Reoperation
Upper Extremity / blood supply*
Grant Support
ID/Acronym/Agency:
T32 CA126607/CA/NCI NIH HHS; T32 CA126607-01A2/CA/NCI NIH HHS
Comments/Corrections

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