Onset of arterial 'steal' following proximal angioaccess: immediate and delayed types

Lazarides, Miltos K.; Staramos, Demitrios N.; Kopadis, George C.; Maltezos, Chrisostomos; Tzilalis, Vasilios D.; Georgiadis, George S.

doi:10.1093/ndt/gfg346

Cited by 104 publications

(103 citation statements)

References 14 publications

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“…U.S. literature recognises the steal syndrome and deals with it mainly in fi stulas performed using the ePTFE graft 21,22 . The steal syndrome shows early manifestations in fi stulas performed with a graft as opposed to their later manifestation in autogenous fi stulas in connection with fi stula development 23 . Diabetes mellitus is considered a risk factor for the occurrence of this complication 11,16,[24][25][26][27][28] .…”

Section: Resultsmentioning

confidence: 96%

“…In the brachiocephalic and brachiobasilic fi stulas it even appears in as much as 10-25 % 19 . Its manifestations include cold sensation and pallor of the limb, pain while working or during dialysis, sensitivity loss, cramps and pain while resting, the development of ulcers, necrosis to tissue loss 19,23 . In certain cases, the problems are not caused by the steal syndrome but rather by ischemic monomelic neuropathy 35,36 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Bachleda¹,

Utíkal²,

Kojecký³

et al. 2007

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background:The autogenous brachiocefalic or brachiobasilic arteriovenous elbow fi stula is not considered to be only the secondary haemodialysis access. In patients with an unsuitable forearm vessel bundle, it is indicated as primary access and it is the method preferred to the fi stula creation using a vascular prosthesis. Its rather rare complication is the development of upper extremity ischemia.Aim: To summarise current knowledge of this fi stula type and its associated complications Methods: Review of the literature. Results:The creation and maturation of the fi stula and occurrence of the steal syndrome is infl uenced by a number of factors. The analysis and awareness of such factors will provide for creation of a suitable fi stula as well as for timely complication diagnostics and treatment.Conclusions: The autogenous elbow fi stula utilising the brachial artery and the cephalic or basilic vein in the upper extremity represents a high-quality haemodialysis access. Its potential complication is the occurrence of the steal syndrome. Its occurrence and manifestations do not constitute indications for ligation of the access. The gathered information shows that a suitable surgical procedure can help meet the basic rule for haemodialysis access -resolving the ischemia and maintaining the access.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Bachleda¹,

Utíkal²,

Kojecký³

et al. 2007

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The patient was submitted to DRIL, the symptoms disappeared and the access was maintained 13 . The patient may occasionally present paresthesia distal to the anastomosis due to flow decrease of the vasa nervorum, a symptom that tends to be limited 4 . Eletrophysiological studies allowed differential diagnosis with similar diseases such as the carpal tunnel syndrome 14,15 .…”

Section: Discussionmentioning

confidence: 99%

“…The latter presents a typical clinical picture called steal syndrome, which may result in limb loss in severe cases 4 . The most common treatment is AVF ligation aiming at restoration of distal blood flow 5 .…”

Section: Introductionmentioning

confidence: 99%

Tratamento da síndrome de roubo de fístula arteriovenosa pela técnica de revascularização distal e ligadura arterial: relato de três casos

et al. 2012

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Fístulas arteriovenosas para hemodiálise podem apresentar complicações a longo prazo. Entre as complicações mais raras, há a isquemia distal por síndrome de roubo. Os autores relataram a experiência de três casos de pacientes portadores de fístulas braquiocefálicas, em funcionamento por longo prazo e que evoluíram com isquemia crítica do membro, sem resposta com tratamento clínico. Com o intuito de tratar esta afecção e preservar o acesso vascular, optou-se pela realização da revascularização distal interposta por ligadura arterial. Devido à raridade dos casos, relatou-se a experiência e apresentou-se uma revisão de literatura.

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“…Risk factors for steal include atherosclerotic disease, female gender, age greater than 60 years, diabetes mellitus, previous surgery on the same arm, and use of the brachial artery as a donor. 3 Symptoms of ischemic steal typically present within the first month after surgery, but can also be delayed; there is one report of a patient presenting one year postoperatively. 4 Imaging studies such as doppler and angiography can be helpful in diagnosing ischemic steal syndrome.…”

Section: Commentarymentioning

confidence: 99%

Nerves of steal

Thompson

Ajam

Stien

et al. 2008

Journal of Hospital Medicine

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A 60 year-old woman with advanced kidney disease presented with one month of progressively worsening, sharp burning pain and decreased sensation in her left hand. Cold air exacerbated the pain. She noted decreasing ability to utilize her left fingers, a weakened grip and that the muscles in her hand looked smaller.Localized sensory and motor symptoms in a discrete region of a single limb suggest neuropathy. The lack of symptoms in the face or ipsilateral lower extremity would dissuade a clinician from considering central etiologies; the presence of neuropathic pain is uncommon for cortical lesions. The involvement of motor and sensory nerves indicates peripheral nerve involvement.The general approach to patients with peripheral neuropathy begins with identifying the neuropathy as a mononeuropathy (involving a single nerve), a polyneuropathy (symmetric involvement of multiple nerves) or a mononeuropathy multiplex (asymmetric involvement of multiple nerves). The patient, in this case, described subacute neuropathic pain, sensory loss, and weakness in her left hand in a distribution consistent with mononeuropathy or mononeuropathy multiplex.This patient could have carpal tunnel syndrome given its prevalence in patients with advanced renal disease. The differential diagnosis is broad, however, and includes ulnar mononeuropathy, nerve ischemia due to vasculitis or vasculopathy, lower cervical radiculopathy (though the patient does not describe neck or radicular pain), lower brachial plexopathy, and complex regional pain syndrome.The patient was diagnosed with advanced kidney disease one year ago when biopsy revealed focal segmental glomerulosclerosis secondary to lithium. Since her diagnosis, two grafts were placed in the left upper arm in anticipation of dialysis: the first, placed seven months prior to this admission, failed to mature; the second, placed one month prior to this admission, was complicated by bleeding at the fistula site and was not yet mature. Prior to this admission she had not required hemodialysis. Her past history included hypertension, dyslipidemia, hypothyroidism, secondary hyperparathyroidism, a remote history of cervical cancer (stage unknown, recent PAP smear negative), microcytosis and schizoaffective disorder. Her medications were furosemide, amlodipine, lisinopril, atenolol, atorThe approach to clinical conundrums by an expert clinician is revealed through presentation of an actual patient's case in an approach typical of morning report. Similar to patient care, sequential pieces of information are provided to the clinician who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. 342

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Onset of arterial 'steal' following proximal angioaccess: immediate and delayed types

Cited by 104 publications

References 14 publications

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Tratamento da síndrome de roubo de fístula arteriovenosa pela técnica de revascularização distal e ligadura arterial: relato de três casos

Nerves of steal

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