Skip to main content

Advertisement

SpringerLink
Log in

Dialysezugangsassoziierte Extremitätenischämie (DAI)

Dialysis access-associated ischemia (DAI) of the extremities

  • Leitthema
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Als Folge des steten Anstiegs des medianen Alters inzidenter und prävalenter Dialysepatienten und der gleichzeitigen Zunahme des Anteils von Diabetikern unter ihnen sehen wir immer häufiger Patienten mit peripheren Ischämien in Assoziation mit ihrem arteriovenösen (AV) Gefäßzugang. Ursächliche arterielle Einstromstenosen können meist interventionell behoben werden. Meist hat die dialysezugangsassoziierte Ischämie (DAI) jedoch ihre Ursache in einem erhöhten peripheren, arteriellen Abstromwiderstand. In diesen Fällen sind dann häufig komplexe gefäßchirurgische Korrektureingriffe erforderlich. Prä- und intraoperative Flussmessungen sind von großem Wert für eine differenzierte und erfolgreiche Therapie mit dem Ziel des Erhalts von Gefäßzugang und Extremität. Abhängig vom präoperativ gemessenen Shuntfluss können den Fluss reduzierende oder umleitende Operationen zur Anwendung kommen. Die einzelnen Verfahren werden dargestellt und bewertet

Abstract

Due to the continuous rise of the median age of incident and prevalent hemodialysis patients and the simultaneous increase in the proportion of diabetics among them, patients with peripheral ischemia in association with arteriovenous (AV) vascular access has become a growing problem. Arterial inflow obstructions causing ischemia and access failure can often be treated interventionally. In the majority of patients with dialysis access-associated ischemia (DAI), however, ischemia is basically caused by a significant rise in peripheral arterial outflow resistance. In these cases complex vascular surgical corrective interventions are frequently necessary. Preoperative and intraoperative flow measurements are essential for a differentiated and successful treatment aiming at preservation of the vascular access and the extremity. Depending on the shunt flow measured preoperatively, flow-reducing or flow-diverting procedures can be applied. The various techniques are presented and assessed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Anaya-Ayala JE, Pettigrew CD, Ismail N et al (2012) Management of dialysis-associated „steal“ syndrome with DRIL procedure: challenges and outcomes. J Vasc Access 13:299–302

    Article  PubMed  Google Scholar 

  2. Aschwanden M, Hess P, Labs KH, Dickenmann M, Jaeger KA (2003) Dialysis access-related steal syndrome: the intraoperative use of duplex ultrasound scan. J Vasc Surg 37:211–213

    Article  PubMed  Google Scholar 

  3. Asif A, Leon C, Merrill D et al (2006) Arterial steal syndrome: a modest proposal for an old paradigm. Am J Kidney Dis 48:88–97

    Article  PubMed  Google Scholar 

  4. Berman SS, Gentile AT, Glickman MH et al (1997) Distal revascularization-interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome. J Vasc Surg 26:393–402

    Article  CAS  PubMed  Google Scholar 

  5. Bourquelot P, Corbi P, Cussenot O (1989) Surgical improvement of high-flow arteriovenous fistulas. In: Sommer BG, Henry ML (Hrsg) Vascular access for hemodialysis. Pluribus Press Inc, Hong Kong, S 124

    Google Scholar 

  6. Brescia MJ, Cimino JE, Appel K, Hurwich BJ (1966) Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 275:1089–1092

    Article  CAS  PubMed  Google Scholar 

  7. Bussell JA, Abbott JA, Lim RC (1971) A radial steal syndrome with arteriovenous fistula for hemodialysis. Studies in seven patients. Ann Intern Med 75:387–394

    Article  CAS  PubMed  Google Scholar 

  8. Callaghan CJ, Mallik M, Sivaprakasam R, Iype S, Pettigrew GJ (2011) Treatment of dialysis-access-associated steal syndrome with the „revision using distal inflow“ technique. J Vasc Access 12:52–56

    Article  PubMed  Google Scholar 

  9. Chemla ES, Morsy M, Anderson L, Whitemore A (2007) Inflow reduction by distalization of anastomosis treats efficiently high-inflow high-cardia output vascular access for hemodialysis. Semin Dial 20:68–72

    Article  PubMed  Google Scholar 

  10. Corfield L, Muller J, Ryan J, Bond R (2012) Distalization of the anastomosis: an effective treatment for dialysis access-associated steal syndrome. Ann Vasc Surg 26:572.e11–572.e13

    Article  Google Scholar 

  11. Davidson I, Beathard G, Gallieni M, Ross J (2017) The DRIL procedure for arteriovenous access ischemic steal: a controversial approach. J Vasc Access 18:1–2

    Article  PubMed  Google Scholar 

  12. DeCaprio JD, Valentine RJ, Kakish HB et al (1997) Steal syndrome complicating hemodialysis access. Cardiovasc Surg 5:648–653

    Article  CAS  PubMed  Google Scholar 

  13. Duijm LEM, Liem YS, van der Rijt RHH et al (2006) Inflow stenoses in dysfunctional hemodialysis access fistulae and grafts. Am J Kidney Dis 48:98–105

    Article  PubMed  Google Scholar 

  14. Gerrickens MWM, Yadav R, Wouda R, Beerenhout CH, Scheltinga MRM (2021) Severe hemodialysis access-induced distal ischemia may be associated with poor survival. J Vasc Access 22:194–202

    Article  PubMed  Google Scholar 

  15. Goel N, Miller GA, Jotwani MC et al (2006) Minimally invasive limited ligation endoluminal-assisted revision (MILLER) for the treatment of dialysis access-associated steal syndrome. Kidney Int 70:765–770

    Article  CAS  PubMed  Google Scholar 

  16. Gradman WS, Laub J, Cohen W (2005) Femoral vein transposition for arteriovenous hemodialysis access: improved patient selection and intraoperative measures reduce postoperative ischemia. J Vasc Surg 41:297–284

    Article  Google Scholar 

  17. Gradman WS, Pozkiris C (2004) Analysis of options for mitigating hemodialysis access-related ischemic steal phenomena. Ann Vasc Surg 18:59–65

    Article  PubMed  Google Scholar 

  18. Guerra A, Raynaud A, Beyssen B et al (2002) Arterial percutaneous angioplasty in upper limbs with vascular access devices for haemodialysis. Nephrol Dial Transplant 17:843–851

    Article  PubMed  Google Scholar 

  19. Gupta NY, You HY, Konig GIV et al (2011) Treatment strategies of arterial steal after arteriovenous access. J Vasc Surg 54:162–167

    Article  PubMed  Google Scholar 

  20. Haimov M, Schanzer H, Skladani M (1996) Pathogenesis and management of upper-extremity ischemia following angioaccess surgery. Blood Purif 14:350–354

    Article  CAS  PubMed  Google Scholar 

  21. Hansrani V, Muhammad K, Charlswood N, Al-Khaffaf H (2019) The afficacy of the secondary extension technique in the management of arterio-venous fistula-associated steal syndrome. J Vasc Access 20:592–956

    Article  PubMed  Google Scholar 

  22. Huber TS, Brown MP, Seeger JM, Lee WA (2008) Midterm outcome after the distal revascularization and interval ligation (DRIL) procedure. J Vasc Surg 48:926–932

    Article  PubMed  Google Scholar 

  23. Hye RJ, Wolf YG (1994) Ischemic monomelic neuropathy: an under-recognized complication of hemodialysis access. Ann Vasc Surg 8:578–582

    Article  CAS  PubMed  Google Scholar 

  24. Jennings WC, Mallios A, Mushtaq N (2018) Proximal radial artery arteriovenous fistula for hemodialysis vascular access. J Vasc Surg 67(1):244–253. https://doi.org/10.1016/j.jvs.2017.06.114

    Article  PubMed  Google Scholar 

  25. Katz S, Kohl RD (1996) The treatment of hand ischemia by arterial ligation and upper extremity bypass after angioaccess surgery. J Am Coll Surg 183:239–242

    CAS  PubMed  Google Scholar 

  26. Knox RC, Berman SS, Hughes JD, Gentile AT, Mills JL (2002) Distal revascularization-interval ligation: a durable and effective treatment for ischemic syndrome after hemodialysis access. J Vasc Surg 36:250–256

    Article  PubMed  Google Scholar 

  27. Konner K, Hulbert-Shearon TE, Roys EC, Port FK (2002) Tailoring the initial vascular access for dialysis patients. Kidney Int 62:329–338

    Article  PubMed  Google Scholar 

  28. Korsetz A, Kantarovsky A, Lehmann J et al (2003) The „DRIL“ procedure—a neglected way to treat the „steal“ syndrome of the hemodialysed patient. Isr Med Assoc J 5:782–785

    Google Scholar 

  29. Lazarides MK, Staramos DN, Panagopoulos GN et al (1998) Indications for surgical treatment of angioaccess-induced arterial steal. J Am Coll Surg 187:422–426

    Article  CAS  PubMed  Google Scholar 

  30. Leake AE, Winger DG, Leers SA, Gupta N, Dillavou ED (2015) Management and outcomes of dialysis access-associated steal syndrome. J Vasc Surg 61:754–761

    Article  PubMed  Google Scholar 

  31. Loh TM, Bennett ME, Peden EC (2016) Revision using distal inflow is a safe and effective treatment for ischemic steal syndrome and pathologic high flow after access creation. J Vasc Surg 63:441–444

    Article  PubMed  Google Scholar 

  32. Malik J, Slavikova M, Maskova J (2003) Dialysis-associated steal syndrome: the role of ultrasonography. J Nephrol 16:903–907

    PubMed  Google Scholar 

  33. Mallios A, Boura B, Costanzo A, Combes M (2018) Pseudoaneurysm caused from banding failure. J Vasc Access 19:392–395

    Article  PubMed  Google Scholar 

  34. Meyer F, Müller JS, Grote R et al (2002) Fisteldrosselung – erfolgversprechendes Konzept bei peripherer Minderperfusion. Zentralbl Chir 127:685–688

    Article  CAS  PubMed  Google Scholar 

  35. Miller GA, Goel N, Friedman A et al (2010) The MILLER banding procedure is an effective method for treating dialysis-associated steal syndrome. Kidney Int 77:359–366

    Article  PubMed  Google Scholar 

  36. Miller GA, Khariton K, Kardos SV et al (2008) Flow interruption of the distal radial artery: treatment for finger ischemia in a matured radiocephalic AVF. J Vasc Access 9:58–63

    Article  CAS  PubMed  Google Scholar 

  37. Minion DJ, Moore E, Endean E (2005) Revision using distal inflow: a novel approach to dialysis-associated steal syndrome. Ann Vasc Surg 19:625–628

    Article  PubMed  Google Scholar 

  38. Misskey J, Yang C, MacDonald S, Baxter K, Hsiang Y (2016) A comparison of revision using distal inflow and distal revascularization-interval ligation for the management of severe access-related hand ischemia. J Vasc Surg 63:1574–1581

    Article  PubMed  Google Scholar 

  39. Morsy AH, Kulbaski M, Chen C et al (1998) Incidence and characteristics of patients with hand ischemia after a hemodialysis access procedure. J Surg Res 74:8–10

    Article  CAS  PubMed  Google Scholar 

  40. Odland MD, Kelly PH, Ney AL et al (1991) Management of dialysis-associated steal syndrome complicating upper extremity arteriovenous fistulas: use of intraoperative digital photoplethysmography. Surgery 110:664–669

    CAS  PubMed  Google Scholar 

  41. Riggs JE, Moss AH, Labosky DA et al (1989) Upper extremity ischemic monomelic neuropathy: a complication of vascular access procedures in uremic patients. Neurology 39:997–998

    Article  CAS  PubMed  Google Scholar 

  42. Rivers SP, Scher LA, Veith FJ (1992) Correction of steal syndrome secondary to hemodialysis fistulas: a simplified quantitative technique. Surgery 112:593–597

    CAS  PubMed  Google Scholar 

  43. Scali ST, Chang CK, Raghinaru D et al (2013) Prediction of graft patenca and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia. J Vasc Surg 57:451–458

    Article  PubMed  Google Scholar 

  44. Schanzer H, Eisenberg D (2004) Management of steal syndrome resulting from dialysis access. Semin Vasc Surg 17:45–49

    Article  PubMed  Google Scholar 

  45. Schanzer H, Schwartz M, Harrington E, Haimov M (1988) Treatment of ischemia due to „steal“ by arteriovenous fistula with distal artery ligation and revascularization. J Vasc Surg 7:770–773

    CAS  PubMed  Google Scholar 

  46. Schanzer H, Skladany M, Haimov M (1992) Treatment of angioaccess-induced ischemia by revascularization. J Vasc Surg 16:861–866

    Article  CAS  PubMed  Google Scholar 

  47. Scheltinga MR, Van Hoek F, Bruyninckx CMA (2009) Surgical banding for refractory hemodialysis access-induced distal ischemia (HAIDI). J Vasc Access 10:43–49

    Article  CAS  PubMed  Google Scholar 

  48. Sessa C, Riehl G, Porcu P et al (2004) Treatment of hand ischemia following angioaccess surgery using the distal revascularization—interval ligation technique with preservation of vascular access: description of an 18-case series. Ann Vasc Surg 18:685–694

    Article  PubMed  Google Scholar 

  49. Shintaku S, Kawanishi H, Moriishi M et al (2015) Modified MILLER banding procedure for managing high-flow access and dialysis-associated steal syndrome. J Vasc Access 16:227–232

    Article  PubMed  Google Scholar 

  50. Shukla PA, Kolber MK, Nwoke F et al (2016) The MILLER banding procedure as a treatment alternative for dialysis access steal syndrome: a single institutional experience. Clin Imaging 40:369–572

    Article  Google Scholar 

  51. Sivanesan S, Bakran A, How T (1998) Characterising flow distributions in AV fistulae for haemodialysis access. Nephrol Dial Transplant 13:3108–3110

    Article  CAS  PubMed  Google Scholar 

  52. Södermann M, Lindholt JS, Clausen LL (2018) The transposed femoral vein arteriovenous fistula for hemodialysis. J Vasc Access 20:169–174

    Article  Google Scholar 

  53. Stierli P, Blumberg A, Pfister J, Zehnder C (1998) Surgical treatment of „steal syndrome“ induced by arteriovenous grafts for hemodialysis. J Cardiovasc Surg 39:441–443

    CAS  Google Scholar 

  54. Taylor SM, Eaves GL, Weatherford DA et al (1996) Results and complications of arteriovenous access dialysis grafts in the lower extremity: a five year review. Am Surg 62:188–191

    CAS  PubMed  Google Scholar 

  55. Teixeira G, Almeida P, Loureiro L et al (2020) Arterial percutaneous angioplasty in hemodialysis accss: endovascular treatment of hand ischemia. J Vasc Access 22:411–416

    Article  PubMed  Google Scholar 

  56. Teixeira G, Almeida P, Sousa CN et al (2017) Arteriovenous access banding revisited. J Vasc Access 18:225–231

    Article  PubMed  Google Scholar 

  57. Thermann F, Ukkat J, Wollert U et al (2007) Dialysis shunt-associated steal syndrome (DASS) following brachial accesses: the value of fistula banding under blood flow control. Langenbecks Arch Surg 392:731–737

    Article  PubMed  Google Scholar 

  58. Thermann F, Wollert U (2009) Proximalization of the arterial inflow: new treatment of choice in patients with advanced dialysis shunt-associated steal syndrome? Ann Vasc Surg 23(4):485–490. https://doi.org/10.1016/j.avsg.2008.09.008

    Article  PubMed  Google Scholar 

  59. Tordoir JH, Dammers R, van der Sande FM (2004) Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 27:1–5

    Article  CAS  PubMed  Google Scholar 

  60. Vaes RH, van Loon M, Vaes SM et al (2015) One-year efficacy of the RUDI technique for flow reduction in high-flow autologous brachial-artery based hemodialysis vascular access. J Vasc Access 16(9):S96–101

    Article  PubMed  Google Scholar 

  61. Walz P, Ladowski JS, Hines A (2007) Distal revascularization and interval ligation (DRIL) procedure for the treatment of ischemic steal syndrome after arm arteriovenous fistula. Ann Vasc Surg 21(4):468–473. https://doi.org/10.1016/j.avsg.2006.08.006

    Article  PubMed  Google Scholar 

  62. Weaver ML, Holscher CM, Graham A, Reifsnyder T (2021) Distal revascularization and interval ligation for dialysis access-related ischemia is best performed using arm vein conduit. J Vasc Surg 73:1368–1375

    Article  PubMed  Google Scholar 

  63. Wixon CL, Hughes JD, Mills JL (2000) Understanding strategies for the treatment of ischemic steal syndrome after hemodialysis access. J Am Coll Surg 191:301–310

    Article  CAS  PubMed  Google Scholar 

  64. Yu SH, Cook PR, Canty TG et al (2008) Hemodialysis-related steal syndrome: predictive factors and response to treatment with the distal revascularization-interval ligation procedure. Ann Vasc Surg 22:210–214

    Article  PubMed  Google Scholar 

  65. Zanow J, Kruger U, Scholz H (2006) Proximalization of the arterial inflow: a new technique to treat access-related ischemia. J Vasc Surg 43:1216–1221

    Article  PubMed  Google Scholar 

  66. Zanow J, Petzold K, Petzold M, Krueger U, Scholz H (2006) Flow reduction in high-flow arteriovenous access using intraoperative flow monitoring. J Vasc Surg 44:1273–1278

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Gefäßchirurgie, Klinikum Mittelbaden Rastatt/Forbach, Standort Rastatt, Engelstraße 39, 76437, Rastatt, Deutschland

    Volker Mickley

Authors
  1. Volker Mickley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Volker Mickley.

Ethics declarations

Interessenkonflikt

V. Mickley gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mickley, V. Dialysezugangsassoziierte Extremitätenischämie (DAI). Gefässchirurgie 26, 502–509 (2021). https://doi.org/10.1007/s00772-021-00825-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-021-00825-6

Schlüsselwörter

Keywords

Search

Navigation