European Journal of Vascular & Endovascular Surgery
Volume 32, Issue 3 , Pages 309-315, September 2006

Strategies for Predicting and Treating Access Induced Ischemic Steal Syndrome

  • G.S. Tynan-Cuisinier

      Affiliations

    • Section of Vascular Surgery, The University of Arizona Health Sciences Center, Tucson, AZ, USA
    • ,
  • S.S. Berman

      Affiliations

    • The Southern Arizona Vascular Institute, Tucson, AZ, USA
    • Section of Vascular Surgery, The University of Arizona Health Sciences Center, Tucson, AZ, USA
    • Corresponding Author InformationCorresponding author. Scott S. Berman, MD, FACS, The Southern Arizona Vascular Institute, 6060 Fountain Plaza Dr, Ste 180, Tucson, AZ 85704, USA.

Accepted 12 January 2006. published online 14 February 2006.

Access induced ischemia is an uncommon but devastating complication for patients maintained on hemodialysis. A number of clinical risk factors have been identified to select patients at risk. Intraoperative measurement of the digital–brachial index may further distinguish at-risk patients when the DBI is <0.45. Once clinically significant steal has developed, surgical strategies to treat this problem should ideally reverse the ischemia while maintaining uninterrupted access for hemodialysis. To date, the distal revascularization–interval ligation or DRIL procedure has been the most consistently successful tactic in achieving these dual objectives. A number of alternative strategies have recently been proposed and will be discussed.

Keywords: Hemodialysis complications, Ischemia

 

 Update on Renal Access and Transplantation-one of a series of educational articles edited by Mr Christopher Gibbons, Swansea, UK.

PII: S1078-5884(06)00039-6

doi:10.1016/j.ejvs.2006.01.003

European Journal of Vascular & Endovascular Surgery
Volume 32, Issue 3 , Pages 309-315, September 2006

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