| Hemodialysis-related steal syndrome: predictive factors and response to treatment with the distal revascularization-interval ligation procedure. | |
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MedLine Citation:
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PMID: 18346574 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Hand ischemia due to steal causes major disability in affected members of the hemodialysis population. Between February 2000 and March 2007, 24 patients aged 37-77 years were identified who developed hand ischemia distal to a hemodialysis access and required a distal revascularization-interval ligation (DRIL) procedure. Of the 24 patients, 22 (92%) were diabetic, 14 (58%) were women, 7 (29%) had prosthetic grafts, and 17 (71%) had fistulas, all originating from the brachial artery. Duration between the initial dialysis access and the DRIL procedures ranged 12 hours to 10 months. Conduits used were saphenous vein in 13 (54%) cases, cephalic vein in 3 (12%) cases, basilic vein in 5 (21%) cases, and prosthetic grafts in 3 (12%) cases. There were no operative deaths. Improved blood flow and relief of symptoms were observed in 23 (96%) patients. The procedure failed early in one patient who had thrombosis of a prosthetic graft. Two patients required digital amputations. At a median follow-up of 50 months, 14 (58%) patients died using the access requiring the DRIL, 2 (8%) did not require dialysis, 3 (12%) were using a new access, and 5 (21%) were still using the access that had required the DRIL. In late follow-up, only one DRIL bypass required revision and the remainder were patent. One patient developed an ischemic hand 5 years after his DRIL procedure despite a patent bypass. The development of ischemic steal requiring performance of a DRIL procedure is most likely to occur in diabetic patients with dialysis access originating from the brachial artery. The procedure is effective in ameliorating symptoms while preserving the vascular access. The high long-term mortality rate observed in this series underscores the fact that patients requiring a DRIL procedure represent a subset of dialysis patients with advanced diabetic vascular disease and a limited life expectancy. Despite the effectiveness of the DRIL procedure, efforts should be concentrated on prevention of ischemic steal in order to lessen the morbidity and expense of this condition in the dialysis population. |
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Authors:
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Son Ha Yu; Patrick R Cook; Timothy G Canty; Robert F McGinn; Peter M Taft; Robert J Hye |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of vascular surgery Volume: 22 ISSN: 0890-5096 ISO Abbreviation: Ann Vasc Surg Publication Date: 2008 Mar |
Date Detail:
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Created Date: 2008-03-18 Completed Date: 2008-07-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 210-4 Citation Subset: IM |
Affiliation:
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Department of Surgery, Southern California Permanente Medical Group and Kaiser Foundation Hospital, San Diego, CA 92120, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Arm
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blood supply Arteriovenous Shunt, Surgical / adverse effects* Female Hand / blood supply* Humans Ischemia / etiology, surgery* Ligation Male Middle Aged Renal Dialysis* Vascular Surgical Procedures* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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