Vascular access steal syndrome
Encyclopedia
In nephrology
, vascular access steal syndrome or Dialysis-associated Steal Syndrome (DASS), also known less precisely as steal syndrome, refers to vascular insufficiency
resulting from an arteriovenous fistula or synthetic vascular graft-AV fistula).
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.
Nephrology
Nephrology is a branch of internal medicine and pediatrics dealing with the study of the function and diseases of the kidney.-Scope of the specialty:...
, vascular access steal syndrome or Dialysis-associated Steal Syndrome (DASS), also known less precisely as steal syndrome, refers to vascular insufficiency
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
resulting from an arteriovenous fistula or synthetic vascular graft-AV fistula).
Signs
- PallorPallorPallor is a reduced amount of oxyhaemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, stimulant use, lack of exposure to sunlight, anaemia or genetics....
- Diminished pulsePulseIn medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...
s (distal to the fistula) - Necrosis
- Decreased wrist-brachialBrachial arteryThe brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...
index (ratio of blood pressureBlood pressureBlood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
measured in the wrist and the blood pressure measured in the upper arm), especially if below 0.6
Treatment
The fistula flow can be restricted through banding, or modulated through surgical revision.Revascularization Techniques
- DRILDRILDRIL is a surgical method of treating vascular access steal syndrome.-Procedure:A short distal bypass is created and the artery just distal to the AV anastomosis is ligated....
(Distal Revascularisation and Interval Ligation) procedure - PAIPai-People:* Pai , includes Konkani region of India name origin, plus people with the name* Pai , includes Chinese name origin, plus people with the name...
(Proximalization of the Arterial Inflow) - RUDI ( Revision Using Distal InflowRevision using distal inflowRevision Using Distal Inflow is a surgical treatment for Dialysis-associated Steal Syndrome.-Procedure:The fistula is ligated at a location slightly proximal to the anastomosis. A bypass to the venous outflow is then created from a distal arterial source....
)
Banding Techniques
- Narrowing suture
- Plication
- Minimally invasive MILLER bandingMILLER bandingMinimally Invasive Limited Ligation Endoluminal-assisted Revision banding is a minimally invasive technique for banding dialysis accesses in cases of Dialysis-associated Steal Syndrome.-Procedure:...
- 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.