Skip to main content
SpringerLink
Log in

Dialysis Shunt-Associated Steal Syndrome with Autogenous Hemodialyis Accesses: Proposal for a New Classification Based on Clinical Results

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Dialysis-associated steal syndrome (DASS) is a multifactorial complication. There are several therapeutic options, although because of the lack of research decisions for certain procedures are often made individually. The aim of this retrospective survey was to propose a new classification for DASS, including therapeutic recommendations, to make standardized procedures easier.

Methods

A total of 63 patients (2001–2006) treated for DASS following autogenuous hemodialysis access (HA) were included in this survey. In 55 (87%) of these patients, surgery was performed. The courses of disease of the patients were evaluated according to clinical symptoms, HA-specific features, and therapeutic results. Statistical evaluation was performed by SSPS software.

Results

Eight patients with mild symptoms were treated successfully using conservative therapy. In 17 patients with pain during exercise or acute neurologic deficiencies, HA banding led to good results. In the case of acral lesions, however, banding was unsuccessful, although interruption of the retrograde flow was sufficient therapy in 94% of cases. Preservation of the HA was unsuccessful in all patients with extended tissue loss (n = 10). Statistical evaluation showed that tissue loss was generally associated with diabetes (p < 0.001) and peripheral arterial occlusive disease (p = 0.001).

Conclusion

In addition to steal phenomenon (stage I), which can be treated conservatively, there are three stages of DASS following autogenuous HA that require surgical intervention (stage II, no acral lesions; stage III, small acral lesions; stage IV, extended acral lesions). HA banding leads to good results in stage II; in patients with stage III, interruption of the retrograde flow is indicated. However, in patients with extensive tissue loss (stage IV), closure of the HA should be considered.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yeager RA, Moneta GL, Edwards JM et al (2002) Relationship of hemodialysis access to finger gangrene in patients with end-stage renal disease. J Vasc Surg 36:245–249

    Article  PubMed  Google Scholar 

  2. 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  PubMed  CAS  Google Scholar 

  3. White JG, Kim A, Josephs LG et al (1999) The hemodynamics of steal syndrome and its treatment. Ann Vasc Surg 13:308–312

    Article  PubMed  CAS  Google Scholar 

  4. Unek IT, Birklik M, Cavdar C et al (2005) Reflex sympathetic dystrophy syndrome due to arteriovenous fistula. Hemodial Int 9:344–348

    Article  PubMed  Google Scholar 

  5. Henriksson AE, Bergqvist D (2004) Steal syndrome after brachiocephalic fistula for vascular access: correction with a new simple surgical technique. J Vasc Access 5:13–15

    PubMed  CAS  Google Scholar 

  6. Davidson D, Louridas G, Guzman R et al (2003) Steal syndrome complicating upper extremity hemoaccess procedures: incidence and risk factors. Can J Surg 46:408–412

    PubMed  Google Scholar 

  7. Lazarides MK, Staramos DN, Kopadis G et al (2003) Onset of arterial “steal” following proximal angioaccess: immediate and delayed types. Nephrol Dial Transplant 18:2387–2390

    Article  PubMed  Google Scholar 

  8. Miles AM (1999) Vascular steal syndrome and ischaemic monomelic neuropathy: two variants of upper limb ischaemia after haemodialysis vascular access surgery. Nephrol Dial Transplant 14:297–300

    Article  PubMed  CAS  Google Scholar 

  9. Roca-Tey R, Rivas A, Samon R et al (2005) Study of vascular access (VA) by Doppler ultrasonography (CDU): comparison between delta-H and CDU methods in measuring VA blood flow rate. Nefrologia 25:678–683

    PubMed  CAS  Google Scholar 

  10. Weinberg DH, Simovic D, Isner J et al (2001) Chronic ischemic monomelic neuropathy from critical limb ischemia. Neurology 57:1008–1012

    PubMed  CAS  Google Scholar 

  11. 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 

  12. Zanow J, Petzold K, Petzold M et al (2006) Flow reduction in high-flow arteriovenous access using intraoperative flow monitoring. J Vasc Surg 44:1273–1278

    Article  PubMed  Google Scholar 

  13. Korzets 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

    PubMed  Google Scholar 

  14. Jean-Baptiste RS, Gahtan V (2004) Distal revascularization-interval ligation (DRIL) procedure for ischemic steal syndrome after arteriovenous fistula placement. Surg Technol Int 12:201–205

    PubMed  Google Scholar 

  15. 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 

  16. Davidson D, Louridas G, Guzman R et al (2003) Steal syndrome complicating upper extremity hemoaccess procedures: incidence and risk factors. Can J Surg 46:408–412

    PubMed  Google Scholar 

  17. Valji K, Hye RJ, Roberts AC et al (1995) Hand ischemia in patients with hemodialysis access grafts: angiographic diagnosis and treatment. Radiology 196:697–701

    PubMed  CAS  Google Scholar 

  18. DeCaprio JD, Valentine RJ, Kakish HB et al (1997) Steal syndrome complicating hemodialysis access. Cardiovasc Surg 6:657–659

    Google Scholar 

  19. Papasavas PK, Reifsnyder T, Birdas TJ et al (2003) Prediction of arteriovenous access steal syndrome utilizing digital pressure measurements. Vasc Endovasc Surg 37:179–184

    Article  Google Scholar 

  20. 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  PubMed  CAS  Google Scholar 

  21. Goff CD, Sato DT, Bloch PH et al (2000) Steal syndrome complicating hemodialysis access procedures: can it be predicted? Ann Vasc Surg 14:138–144

    Article  PubMed  CAS  Google Scholar 

  22. Odland M, 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

    PubMed  CAS  Google Scholar 

  23. Ehsan O, Bhattacharya D, Darwish A et al (2005) Extension technique: a modified technique for brachio-cephalic fistula to prevent dialysis access associated steal syndrome. Eur J Vasc Endovasc Surg 29:324–327

    Article  PubMed  CAS  Google Scholar 

  24. Allon M, Lockhart ME, Lilly RZ et al (2001) Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 60:2013–2012

    Article  PubMed  CAS  Google Scholar 

  25. Aschwanden M, Hess P, Labs KH et al (2003) Dialysis access-associated steal syndrome: the intraoperative use of duplex ultrasound scan. J Vasc Surg 37:211–213

    Article  PubMed  Google Scholar 

  26. Martinelli P, Baruzzi A, Montagna P et al (1981) Carpal tunnel syndrome in a patient with a Cimino-Brescia fistula. Eur Neurol 20:478–480

    Article  PubMed  CAS  Google Scholar 

  27. Harding AE, Le Fanu J (1977) Carpal tunnel syndrome related to antibrachial Cimino-Brescia fistula. J Neurol Neurosurg Psychiatry 40:511–513

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  29. 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 

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

    Article  PubMed  CAS  Google Scholar 

  31. Thermann F, Kornhuber M, Brauckhoff M (2006) Dialysis shunt-associated ischaemic monomelic neuropathy: neurological recovery preserving the dialysis access. Nephrol Dial Transplant 21:3334–3336

    Article  PubMed  Google Scholar 

  32. Zanow J, Petzold K, Petzold M et al (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. Department of General, Visceral, and Vascular Surgery, University Hospital Halle-Wittenberg, Ernst Grube Street 40, Halle, 06097, Germany

    Florian Thermann, Henning Dralle & Michael Brauckhoff

  2. Department of Vascular Surgery, St. Elisabeth and St. Barbara Hospital, Mauerstrasse 5, Halle, 06110, Germany

    Florian Thermann & Ulrich Wollert

  3. Kleine Gosenstrasse 4, 06114, Halle, Germany

    Florian Thermann

Authors
  1. Florian Thermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulrich Wollert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henning Dralle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Brauckhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Thermann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thermann, F., Wollert, U., Dralle, H. et al. Dialysis Shunt-Associated Steal Syndrome with Autogenous Hemodialyis Accesses: Proposal for a New Classification Based on Clinical Results. World J Surg 32, 2309–2315 (2008). https://doi.org/10.1007/s00268-008-9677-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-008-9677-7

Keywords

Search

Navigation