Document Detail

Steal syndrome complicating hemodialysis access.
MedLine Citation:
PMID:  9423952     Owner:  NLM     Status:  MEDLINE    
The purposes of this study were to examine potential causes for arterial steal syndrome in patients with hemodialysis shunts and to evaluate the results of treatment. A retrospective analysis was performed on all hemodialysis patients who presented with arterial steal syndrome over a 3-year period. Medical records were reviewed to determine demographic data, time to development of symptoms, operative details, and treatment outcome. Results of upper-extremity arteriography in the last five patients were also documented. Eighteen patients presented with steal syndrome at a mean of 7(4) months after shunt placement. Four patients had prior ipsilateral grafts. Fifteen (83%) patients had forearm shunts in loop configuration between the main brachial artery and a superficial vein, and three had straight upper-arm shunts. Graft sizes were 6 mm in five patients and 4- to 7 step grafts in 13. Graft banding was used to treat steal in 11 shunts, one of which remained patent. All five patients who underwent upper-extremity arteriography had arterial stenoses demonstrated in the inflow circulation. In conclusion, arterial steal is an uncommon complication of hemodialysis shunts. Shunt location and choice of graft do not appear to be major factors: steal can develop regardless of access site, configuration, or use of straight versus step graft. Banding is an ineffective method of treatment. Arteriography may be important to detect unsuspected inflow stenoses in patients with steal syndrome.
J D DeCaprio; R J Valentine; H B Kakish; R Awad; R T Hagino; G P Clagett
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular surgery (London, England)     Volume:  5     ISSN:  0967-2109     ISO Abbreviation:  Cardiovasc Surg     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-02-04     Completed Date:  1998-02-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9308765     Medline TA:  Cardiovasc Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  648-53     Citation Subset:  IM    
Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, USA.
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MeSH Terms
Arm / blood supply*
Brachial Artery / pathology
Catheters, Indwelling / adverse effects*
Constriction, Pathologic
Ischemia / etiology*,  radiography,  therapy
Middle Aged
Renal Dialysis / adverse effects*
Retrospective Studies
Comment In:
Cardiovasc Surg. 1998 Dec;6(6):657-9   [PMID:  10395271 ]

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