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NDT Advance Access originally published online on September 28, 2007
Nephrology Dialysis Transplantation 2008 23(1):19-24; doi:10.1093/ndt/gfm673
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Steal syndrome—strategies to preserve vascular access and extremity

Volker Mickley

Department of Vascular Surgery, Clinical Centre Mittelbaden, Kreiskrankenhaus Rastatt, Germany

Correspondence and offprint requests to: Dr Volker Mickley, Department of Vascular Surgery, Clinical Centre Mittelbaden, Kreiskrankenhaus Rastatt, Engelstrasse 39, D-76437 Rastatt, Germany. E-mail: v.mickley@klinikum-mittelbaden.de

Keywords: access banding; arteriovenous access; DRIL procedure; PAVA procedure; review; steal syndrome

The first 150 words of the full text of this article appear below.



   Introduction
 
In access-related steal syndrome, four stages can be distinguished (Table 1, [1]). Steal syndrome stage I (retrograde inflow of blood into the access during diastole without complaints) is a frequent finding in arteriovenous (AV) fistulae and grafts [2] and needs no intervention. Patients with pain on exercise or during dialysis (stage II), however, require permanent attention in order to early detect deterioration to stage III (rest pain) or stage IV (necrosis).


View this table:



  		Table 1. Classification of steal syndrome (modified from [1])

 
Depending on the type and location of AV access for HD, the risk of severe access-related peripheral ischaemia (steal syndrome stage III or IV) varies between 1–2% (in distal radio-cephalic AV fistulae) and 5–15% (in brachio-cephalic/basilic fistulae and grafts) [3–6]. Following the creation of a femoral (autogenous or allograft) access, an even higher incidence of steal syndrome (16 to 36%, [7. . . [Full Text of this Article]



   Pathophysiology
 


   Clinical findings
 


   Diagnostic evaluation
 


   Treatment options
 
Arterial inflow obstruction
‘Classical’ steal syndrome


   Ligation
 


   Banding
 


   DRIL and DRAL
 


   PAVA
 


   RUDI
 


   MILLER
 


   Conclusion
 

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P. Zamani, J. Kaufman, and S. Kinlay
Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis
Vascular Medicine, November 1, 2009; 14(4): 371 - 376.
[Abstract] [PDF]