Correction of steal syndrome secondary to hemodialysis access fistulas: A simplified quantitative technique

Steven P. Rivers, Larry A. Scher, Frank J. Veith

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Correction of symptomatic vascular steal distal to an arteriovenous fistula requires either fistula ligation or banding. Ligation carries the obvious disadvantage of destruction of a functioning angioaccess, whereas banding procedures have been plagued by the complexity of many of the reported techniques and by the difficulty of balancing fistula flow with distal perfusion. In this study a simple plication technique is described that avoids the introduction of any additional foreign material and that quantifies distal perfusion by means of intraoperative pulse volume recordings. Five patients have been treated by this method, two with autologous vein fistulas and three with bridge fistulas using polytetra fluorethylene. All five have had resolution of their ischemic symptoms with an increase in intraoperative pulse volume recordings of 5 mm or more. Only three of the patients had restoration of the radial pulse, which was not a specific end point of the banding procedure. Furthermore, all fistulas remained patent for at least 6 months and continued to provide adequate flows for hemodialysis. Banding/plication is clearly preferable to fistula closure for the management of steal syndrome. The method described herein is simple and hemodynamically identifies the minimal constriction that will resolve symptoms and preserve fistula flow.

Original languageEnglish (US)
Pages (from-to)593-597
Number of pages5
JournalSurgery
Volume112
Issue number3
StatePublished - 1992

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Fistula
Renal Dialysis
Ligation
Perfusion
Arteriovenous Fistula
Constriction
Blood Vessels
Pulse
Veins

ASJC Scopus subject areas

  • Surgery

Cite this

Correction of steal syndrome secondary to hemodialysis access fistulas : A simplified quantitative technique. / Rivers, Steven P.; Scher, Larry A.; Veith, Frank J.

In: Surgery, Vol. 112, No. 3, 1992, p. 593-597.

Research output: Contribution to journalArticle

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