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Stealsyndrom nach Dialysezugang

Prophylaxe und Therapieoptionen

Steal syndrome after dialysis access

Prophylaxis and treatment options

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Zusammenfassung

Nach Anlage eines Dialysezugangs sind Stealphänomene [Strömungsumkehr distal der AV-Verbindung (AV: arteriovenös)] und milde Ischämiesymptome häufig, schwere, klinisch relevante Stealsyndrome dagegen relativ selten. Eine eingehende Evaluation des venösen und arteriellen Gefäßsystems erlaubt die Abschätzung des individuellen Stealsyndromrisikos. Dies sollte bei jeder Shuntplanung berücksichtigt werden, denn Details der Shuntanlage entscheiden mitunter über den späteren Verlauf. Bei manifestem Stealsyndrom erfolgt die Shuntkorrektur in Abhängigkeit von Art und Ausmaß der Beschwerden. Ziel ist immer die Beseitigung peripherer Ischämiesymptome bei Erhalt der Shuntfunktion. Shuntfluss und -lokalisation bestimmen maßgeblich das zu wählende Korrekturverfahren. Prinzipielle Ansatzpunkte der Therapie sind die Unterbindung der arteriellen Strömungsumkehr distal der AV-Verbindung, die Schaffung künstlicher, kaliberkräftiger Kollateralen (Bypass) und die Verlagerung der AV-Verbindung nach proximal zu leistungsfähigeren Arterien.

Abstract

After creation of a dialysis access a steal phenomenon (retrograde flow in the artery distal to the arteriovenous anastomosis) and mild symptoms of ischemia are frequently observed, whereas severe clinically relevant steal syndromes rarely occur. A thorough examination of the venous and arterial vascular systems allows the individual risk of developing a steal syndrome to be estimated. This should be taken into account when planning an arteriovenous access in order to minimize the risk as details of the access creation can play an important role during the later course. After development of a relevant steal syndrome the necessity of a correction of the arteriovenous access is determined by the character and extent of complaints. All therapeutic efforts aim at a relief of symptoms of peripheral ischemia while preserving a functional arteriovenous access. Flow and location of an arteriovenous access determine the correct procedure for correction. The underlying principles are the termination of the retrograde flow distal to the arteriovenous anastomosis, the creation of large caliber artificial collaterals (bypass) and the transposition of the arteriovenous anastomosis to a bigger, more proximal feeding artery.

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Danksagung

Klaus Konner und Volker Mickley darf ich für die Durchsicht des Manuskripts und wertvolle Anmerkungen herzlich danken.

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  1. Gefäßchirurgische Klinik, Gemeinschaftsklinikum Koblenz-Mayen, Kemperhof, Koblenzer Straße 115–155, 56073, Koblenz, Deutschland

    J. Schäfer

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Schäfer, J. Stealsyndrom nach Dialysezugang. Gefässchirurgie 15, 549–564 (2010). https://doi.org/10.1007/s00772-010-0841-7

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