Dialysis-associated steal syndrome (DASS)

Abstract

Multiple treatment options exist for steal. We present diagnostic evaluation and management algorithm.

A dialysis patient with subungual hyperkeratosis and ulceration of the fingertips

“…Catheter angiography also allows for the correction of the abnormally high flow rates and distal obstructions. 2 After Doppler ultrasound showed reduced distal flow rates, the patient underwent angiography, which confirmed the diagnosis of DASS ( Fig 3 ; Video 1 , available on www.jaad.org ).

Fig 3

CT angiography – Incorrect.…”

“… 1 DASS can occur acutely following AVF creation or can occur gradually as the fistula matures and dilates from intraluminal pressure. 2 Advanced age, female sex, and diabetes are important risk factors. 3 Our patient’s symptoms started after she underwent a stenting procedure to correct a recently stenotic AVF.…”

“…While magnetic resonance imaging with magnetic resonance angiography has been used for the diagnosis of DASS, it is not as well studied as invasive angiography. 2 Neither magnetic resonance angiography nor CT angiography allows for simultaneous intervention if indicated. Skin biopsy – Incorrect.…”

“…Recently, distal revascularization with interval ligation has become the preferred procedure for most cases of DASS. 2 , 3 Most vascular surgeons are able to perform both percutaneous and open surgical procedures for DASS. The patient underwent banding of the fistula, with improvement in distal angiographic flow.…”

Short interposition grafting for dialysis-access steal syndrome treatment

“…1 Several additional techniques have been reported in the literature, with ligation being the last option. [2][3][4][5][6] Prior DSA with correction of critical stenosis is mandatory and can eliminate the steal in many cases. There are little data in the literature on short interposition grafts for the treatment of dialysis access steal syndrome.…”