Volume Flow Measurements in Arteriovenous Dialysis Access in Patients with and without Steal Syndrome

Abstract

Introduction. Dialysis associated steal syndrome (DASS) constitutes a serious risk for patients undergoing vascular access operations. We aim to assess the measured volume flow using ultrasound in patients with clinically suspected steal syndrome and determine differences in flow among types of arteriovenous (AV) access. Methods. Patients with permanent hemodialysis access with and without ischemic steal underwent duplex ultrasound (US) exams for the assessment of volume flow and quantitative evidence of hemodynamic steal. Volume flow was measured in the proximal feeding artery. Results. 118 patients underwent US of which 82 (69.5%) had clinical evidence of steal. Women were more likely to develop steal compared to men (chi-squared test P < 0.04). Mean volume flow in patients with steal was 1542 mL/min compared to 1087 mL/min (P < 0.002) in patients without evidence of steal. A significant difference in flow volumes in patients with and without steal was only seen in patients with a brachial-cephalic upper arm AV fistula (AVF) (P < 0.002). When comparing different types of access with steal, brachial-cephalic upper arm AVFs had higher volume flows than the upper extremity AV graft (AVG) group (P = 0.04). Conclusion. In patients with DASS, women were more likely to develop steal syndrome. Significantly higher volume flows were seen with brachial-cephalic upper arm AVF in patients with steal compared to those without. A physiologic basis of this US finding may be present, which warrants further study into the dynamics of flow and its relationship to the underlying peripheral arterial pathology in the development of ischemic steal.

Comparative Doppler flow measurements of the ulnar artery and of the postanastomotic radial artery in radiocephalic arteriovenous fistulas to detect steal syndromes

“…The constant aging of the population results in an increase of the occurrence of vascular and metabolic disorders with an impact on renal function, such as arterial hypertension or diabetes, hence, a rise in the number of patients suffering from total renal failure and requiring renal transplantation or hemodialysis (2,3).…”

“…er common steal phenomenon, where the postanastomotic arterial radial flow is reversed, without any concomitant downstream ischemic symptom and the much less frequent steal syndrome, where the retrograde flow is so important that it induces distal clinical signs of vascular arterial deficit (2).…”

“…Steal syndromes occur preferably in older, in female and in diabetic patients (2). Their mechanisms are complex and have not been thoroughly understood yet (7).…”

“…They may also cause amyotrophy, neurological troubles and skin ulcerations (2). A classification of the symptoms has been suggested, similar to that of Leriche and Fontaine for ischemia of the lower limbs (Table I) (1,12).…”

“…In some cases however, the quantity of diverted blood is so important that it induces a distal ischemia a.k.a. steal syndrome, whose clinical diagnosis may prove difficult (1,2).…”