Operative Techniques to Prevent Dialysis Access-associated Steal Syndrome in High Risk Patients Undergoing Surgery for Hemodialysis Access: A Systematic Review

Abstract

Up to 10% of patients suffer from various degrees of dialysis access-associated steal syndrome (DASS) after surgery for hemodialysis access. This systematic review was conducted to find out optimal intra-operative techniques to prevent DASS in high-risk patients.

Short interposition grafting for dialysis-access steal syndrome treatment

“…In this case, the fistula is ligated and blood flow is restored with a venous bypass from the proximal radial or ulnar artery. 1 In conclusion, we believe that our technique represents an…”

“…In addition, we did not use the RUDI technique because of its complexity. In this case, the fistula is ligated and blood flow is restored with a venous bypass from the proximal radial or ulnar artery 1. In conclusion, we believe that our technique represents an alternative flow-limiting procedure for the treatment of access-related steal syndrome in hyperfunctioning fistulas.…”

“…Fistulas with a normal flow have been treated with Distal Revascularisation-Interval Ligation or Proximalisation of Arterial Inflow. 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.…”

“…Fistulas with a high flow are classically corrected with flow-limiting procedures such as banding or Revision Using Distal Inflow (RUDI) procedures. Fistulas with a normal flow have been treated with Distal Revascularisation-Interval Ligation or Proximalisation of Arterial Inflow 1. Several additional techniques have been reported in the literature, with ligation being the last option 2–6.…”

Treatment of Dialysis Access Steal Syndrome with Concomitant Vascular Access Aneurysms

“…Others advocate for the length of the anastomosis to be 75% of the diameter of the brachial artery, not more than 4 mm [ 3 ] or between 4 and 6 mm [ 1 , 9 ]. The creation of the anastomosis to proximal radial or ulnar artery using the median cubital, antecubital, or the deep communicating vein has been reported as “primary extension” [ 3 , 4 , 10 ]. Charlwood and Al-Khaffaf used primary extension in 64 patients with diabetes, with 5% of cases with primary failure and no cases of steal [ 10 ].…”