Steal syndrome complicating hemodialysis access

J. D. Decaprio, R. J. Valentine, H. B. Kakish, R. Awad, R. T. Hagino, G. P. Clagett

Research output: Contribution to journalArticle

110 Scopus citations

Abstract

The purposes of this study were to examine potential causes for arterial steal syndrome in patients with hemodialysis shunts and to evaluate the results of treatment. A retrospective analysis was performed on all hemodialysis patients who presented with arterial steal syndrome over a 3-year period. Medical records were reviewed to determine demographic data, time to development of symptoms, operative details, and treatment outcome. Results of upper-extremity arteriography in the last five patients were also documented. Eighteen patients presented with steal syndrome at a mean of 7(4) months after shunt placement. Four patients had prior ipsilateral grafts. Fifteen (83%) patients had forearm shunts in loop configuration between the main brachial artery and a superficial vein, and three had straight upper-arm shunts. Graft sizes were 6 mm in five patients and 4- to 7 step grafts in 13. Graft banding was used to treat steal in 11 shunts, one of which remained patent. All five patients who underwent upper-extremity arteriography had arterial stenoses demonstrated in the inflow circulation. In conclusion, arterial steal is an uncommon complication of hemodialysis shunts. Shunt location and choice of graft do not appear to be major factors: steal can develop regardless of access site, configuration, or use of straight versus step graft. Banding is an ineffective method of treatment. Arteriography may be important to detect unsuspected inflow stenoses in patients with steal syndrome.

Original languageEnglish (US)
Pages (from-to)648-653
Number of pages6
JournalVascular
Volume5
Issue number6
DOIs
StatePublished - Dec 1997

Keywords

  • access site
  • hemodialysis
  • shunt placement
  • steal syndrome

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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