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Preemptive distal revascularization-interval ligation to prevent ischemic steal after hemodialysis access surgery

Preemptive distal revascularization-interval ligation to prevent ischemic steal after hemodialysis access surgery

Authors :
Oscar H. Grandas
Scott L. Stevens
Michael B. Freeman
Michael Lebow
Mitchell H. Goldman
David C. Cassada
Source :
Journal of surgical education. 64(3)
Publication Year :
2006

Abstract

ialysis access steal syndrome (DASS) occurs in 2% to 8% of atients after hemodialysis access surgery and affects thouands of people in the United States each year. Dialysis ccess steal syndrome occurs when blood that normally suplies a distal arterial bed reverses flow and is redirected hrough the AV fistula. Factors such as high fistula flow rates, ative vessel stenosis or occlusions, and poor collateral flow ct synergistically to cause DASS. Diabetics are particularly rone to developing a steal because of their diffuse calcific icrovascular disease. Fistulas that originate from the brachial rtery are the most at risk for DASS because they lack the ollateral flow found in radial-based fistulas. Autogenous vein rafts dilate slowly and typically result in DASS symptoms that evelop gradually over time while exogenous (PTFE) grafts evelop early ( 24 h) symptoms because of their immediate igh flow rate. Studies of tapered PTFE grafts designed to ncrease resistance, and hypothetically to reduce DASS, have hown little benefit. The symptoms of DASS range from mild, intermittent ain or numbness to tissue loss, motor dysfunction, and ontracture. Frequently, a patient’s symptoms are worse on emodialysis because dialysis lowers the mean arterial presure exacerbating the steal. It is difficult to determine which atients will benefit from early revascularization because ild symptoms often resolve over time and there are no eliable predictors of progression. Valintine et al prospecively performed preoperative finger pressures on 72 patients n an effort to classify patients at risk for DASS. They found n increased incidence of DASS in patients with lower preperative finger pressures but no absolute pressure below hich a steal was inevitable. Digital photoplethysmography, ressure indices, and nerve conduction studies are good ethods to quantitatively follow patients with DASS in the

Details

ISSN :
19317204
Volume :
64
Issue :
3
Database :
OpenAIRE
Journal :
Journal of surgical education
Accession number :
edsair.doi.dedup.....a5799039c71cf638ddb55ac0757a131d