Treatment strategies of arterial steal after arteriovenous access

Abstract

Risk factors for development of ISS include CAD, diabetes, female gender, hypertension, and tobacco use. Among various options to treat ISS, banding has a low success rate and high likelihood for reintervention, while DRIL is particularly effective although not uniformly. Less invasive treatment options such as RUDI and PAI may be quite effective in treating ISS. Use of the PRA as the inflow source may decrease the incidence of ISS.

Distal Revascularization and Interval Ligation “DRIL” Procedure in Steal Syndrome Management in Hemodialysed Patients

“…When distal fistula compressing did not improve symptoms nor plethysmographic curves, ligation alone of the nonfunctioning AVF as well as proximalization or banding of the functioning AVF would have been inconvenient. The value of DRIL is dependent on how could it eliminates ischemic manifestations whilst maintaining patency of AVA [12].…”

“…The risk factors are extended and comprised old age, female sex, DM, peripheral arterial disease, large grafts (i.e., femoral/popliteal vein), and multiple prior procedures [13][14][15][16]. Furthermore, Gupta et al reported that ischemic symptoms due to steal syndrome were more common in females and diabetics [12]. In accordance with previous studies, steal syndrome manifestations in our subjects occurred more in females (59.1%) and in old aged patients and in diabetic patients more than non-diabetics .We did not include subjects with upper limb peripheral arterial disease neither those with previous performed accesses and we used only great saphenous vein as a conduit (≥ 3 mm) as mentioned in exclusion criteria.…”

Stenotic ligature: a simple technique for managing distal hypoperfusion ischemic syndrome following arteriovenous fistulas

“…They require a minimal setting but are prone to eventual failure. Moreover, vein plication and banding have one important disadvantage -the calibration cannot be properly adjusted and once the procedure is finished, it is irreversible and thus impossible to calibrate (13).…”

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

“…It is important for surgical planning to show the distal arterial outflow and the assessment of palmar arch patency [16][17][18] . Many techniques for the treatment of ischemic syndrome in patients with upper fistulas have been described, and they aim to decrease the AVF flow, thus improving distal ischemia and decreasing flow inversion in the distal artery 8,[19][20][21] . One approach is to perform plicature by a longitudinal suture of the venous segment right after the arteriovenous anastomosis, reducing its diameter and, therefore its flow, as shown in Figure 2A.…”

“…It tends to reduce the fistula flow, but longterm follow-up has not been reported yet 20 . When all technical options have been exhausted or limb revascularization is impeded due to extensive calcification, fistula ligation may resolve the ischemic symptoms and a new vascular access may be required 21 .…”