scholarly journals Dialysis Access-Associated Steal Syndrome with Percutaneous Endovascular Arteriovenous Fistula Creation.

2021 ◽  
Author(s):  
Rakesh Varma ◽  
Manuel Betancourt-Torres ◽  
Eric Bready ◽  
Alian Al-Balas
Keyword(s):  
Risk Factors ◽  
Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Ulnar Artery ◽  
Renal Dysplasia ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Vessel Occlusion ◽  
Flow Through ◽  
Steal Syndrome

Abstract Background: Dialysis access-associated steal syndrome is an infrequent complication after hemodialysis access creation. Clinical symptoms depend on the degree of steal. Mild symptoms include coldness, numbness and pain during dialysis. Severe steal can present with rest pain, cyanosis and ulcerations, and may require surgical ligation of the fistula. With recent advances in arteriovenous fistula creation, percutaneous endovascular arteriovenous fistula creation has demonstrated better maturation and patency rates with lower risk of wound healing and infection rates as compared to surgically created hemodialysis access. Percutaneous creation offers a minimally invasive alternative, though complications have been reported. The following presents the first described case of DASS following the use of percutaneous endovascular arteriovenous fistula creation, and discusses risk factors and management. Case Presentation: Our case is that of a 27-year-old male with end stage renal disease due to congenital renal dysplasia, who underwent left percutaneous arteriovenous fistula creation for initiation of dialysis. Two months after the procedure the patient complained of coldness, pain, tingling, and numbness in the left arm during dialysis, concerning for steal syndrome. The patient subsequently underwent brachial artery angiogram, which showed predominant flow through the fistula and minimal antegrade flow through the ulnar and interosseous arteries towards the hand, with a focal, severe stenosis in the distal ulnar artery. Angioplasty of the stenosis was performed, though steal symptoms continued. Conclusions: DASS, though rare, can be seen with percutaneous arteriovenous fistula creation. Identification of the risk factors prior to creation, especially in patients who are at higher risk of peripheral vascular disease, can help avoid this complication. Management is largely guided by clinical presentation. As long as there is adequate collateral supply to the extremity, single vessel occlusion is not a contraindication to percutaneous arteriovenous fistula creation with the use of WavelinQ technology. Careful patient selection with pre-creation angiogram may reduce the risk of symptomatic steal.

Does a failed DRIL mean the end for a fistula? A case report in the use of an Amplatzer plug post DRIL procedure for ongoing steal syndrome

2021 ◽  
pp. 112972982110069
Author(s):  
Gemma Fitzpatrick ◽  
Philip Kiely ◽  
Bora Jeong ◽  
Ewan Macaulay
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Ulnar Artery ◽  
Hybrid Procedure ◽  
Fistula Formation ◽  
Dialysis Access ◽  
Retrograde Flow ◽  
Occlusion Device ◽  
Steal Syndrome

Dialysis access steal syndrome is a well-recognised complication, affecting 1%–8% of all patients who undergo arteriovenous fistula formation particularly those that are brachial based. We present a case of ongoing steal syndrome following a DRIL procedure via retrograde flow in the ulnar artery. This was managed via a hybrid procedure and the use of an Amplatzer plug. This case demonstrates a novel use for the Amplatzer occlusion device, it is also a reminder that failure to occlude the vessel close to the fistula anastomosis can result in continued steal despite a functioning DRIL bypass.

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

2020 ◽  
Vol 3 (2) ◽  
pp. 147-150
Author(s):  
Kaczynski RE ◽  
Asaad Y ◽  
Valentin-Capeles N ◽  
Battista J
Keyword(s):  
Arteriovenous Fistula ◽  
Complete Loss ◽  
Dialysis Access ◽  
Loss Of Function ◽  
Access Site ◽  
Surgical Ligation ◽  
Arteriovenous Access ◽  
Vascular Steal ◽  
Steal Syndrome

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

scholarly journals Best Vascular Access in the Elderly: Time for Innovation?

2018 ◽  
Vol 47 (1-3) ◽  
pp. 236-239 ◽  
Author(s):  
Arif Asif ◽  
Mohamed M. Bakr ◽  
Michael Levitt ◽  
Tushar Vachharajani
Keyword(s):  
Arteriovenous Fistula ◽  
Ulnar Artery ◽  
The Elderly ◽  
Dialysis Access ◽  
Failure Rates ◽  
Early Failure ◽  
Upper Arm ◽  
Arteriovenous Access ◽  
Surgical Manipulation ◽  
Innovative Techniques

Background: Conflicting data continue to surround the optimal dialysis access for the elderly. Many propose that catheters are the best option for this population; others emphasize the creation of an arteriovenous fistula. Summary: While an arteriovenous access is the best available access, it has a high early failure rate, particularly in the elderly. However, significant differences exist in forearm (men ≥65 years ~70%; women ≥65 years ~80%) versus upper arm (men ≥65 years ~40%; women ≥65 years ~38%) fistula failure rates in the elderly, with upper arm having much lower failure rates. Two percutaneous innovative techniques that successfully establish fistulas at the upper arm using proximal radial/ulnar ­artery as the inflow have been recently introduced. These procedures have been successfully performed in the elderly. Importantly, these techniques bypass the open surgical exploration and as such avoid the surgical manipulation of the juxta-anastomotic region (a common cause for the development of juxta-anastomotic stenosis and early fistula failure). Key Message: This article discusses the arteriovenous fistula creation in the elderly, highlights the factors necessary for successful fistula creation, and describes the 2 innovative techniques that can be used to provide a robust platform for successful fistula creation in this population.

Clinical Considerations in Hemodialysis Access Intervention

2018 ◽  
pp. 594-614
Author(s):  
Eric K. Hoffer
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Morbidity And Mortality ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
National Kidney Foundation ◽  
Clinical Considerations ◽  
Stage Renal Disease ◽  
End Stage

Interventional radiologists developed and refined the endovascular approaches to maintenance of the permanent arteriovenous vascular accesses that are integral to the provision of hemodialysis for patients with end stage renal disease. As methods of percutaneous arteriovenous fistula creation expand the scope of IR, this chapter reviews the clinical indications and preferences pertinent to dialysis access creation with respect to National Kidney Foundation Recommendations. Accesses remain imperfect, plagued by the development of flow-limiting intimal hyperplastic stenoses, and require monitoring and maintenance to minimize complications, morbidity and mortality. The measures of dialysis access function used in the surveillance of vascular accesses that indicate potential stenosis, and the utility of pre-occlusion recanalization of these stenoses are discussed. Complications specific to dialysis access interventions are also addressed.

scholarly journals Risk Factors and Management of Steal Syndrome After Hemodialysis Access Creation

2020 ◽  
Vol 72 (1) ◽  
pp. e34
Author(s):  
Shin-Rong Lee ◽  
Alan Dardik ◽  
Jeffrey J. Siracuse ◽  
Cassius I. Ochoa Chaar
Keyword(s):  
Risk Factors ◽  
Hemodialysis Access ◽  
Steal Syndrome

scholarly journals Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Mahmoud Tolba ◽  
Martin Maresch ◽  
Dhafer Kamal
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Hemodialysis Patient ◽  
Ulnar Artery ◽  
Complete Relief ◽  
Retrograde Flow ◽  
Palmar Arch ◽  
Artery Ligation ◽  
Steal Syndrome ◽  
Distal Radial Artery

Abstract We present a case of dialysis associated steal syndrome in a hemodialysis patient with left radiocephalic arteriovenous fistula that caused him severe rest pain. Angiography showed retrograde flow from the ulnar artery to the distal radial artery through a hypertrophied palmar arch. The problem was solved by surgical ligation of the distal radial artery leading to complete relief of patient symptoms without any notable complications.

scholarly journals Dialysis Arteriovenous Fistula Causing Subclavian Steal Syndrome in the Absence of Subclavian Artery Stenosis

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Eesha Maiodna ◽  
Sudheer Ambekar ◽  
Jeremiah N. Johnson ◽  
Mohamed Samy Elhammady
Keyword(s):  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Subclavian Steal Syndrome ◽  
External Compression ◽  
Subclavian Steal ◽  
Retrograde Filling ◽  
Flow Through ◽  
Stage Renal Disease ◽  
End Stage ◽  
Steal Syndrome

We present a rare cause of subclavian steal syndrome secondary to a dialysis arteriovenous fistula (AVF). A 69-year-old female with end-stage renal disease presented with ataxia and recurrent fainting spells. Angiography revealed normal subclavian arteries bilaterally, a right VA origin occlusion, and an apparent left VA origin occlusion. However, carotid artery angiography demonstrated flow through the posterior communicating artery with retrograde filling of the basilar artery and left VA to its subclavian origin. Repeat left subclavian arteriography during external compression of the AVF demonstrated normal antegrade left VA flow. The AVF was subsequently ligated resulting in complete symptom resolution.

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