Dialysis access steal syndromes.

Area of Science:

• Vascular Surgery
• Nephrology
• Ischemic Complications

Background:

• Dialysis-associated steal syndrome (DASS) presents a significant challenge in vascular access surgery.
• Risk factors for DASS include advanced age, diabetes, female sex, cardiac disease, brachial anastomosis, and prior ipsilateral access.
• Diagnosis relies on recognizing a pattern of symptoms and physical findings related to arterial disease and flow dynamics.

Purpose of the Study:

• To emphasize the importance of prompt recognition and treatment of dialysis-associated steal syndromes.
• To highlight the goals of maximizing both limb salvage and vascular access preservation.
• To discuss the management strategies for DASS.

Main Methods:

• Review of clinical presentation and diagnostic challenges in DASS.
• Evaluation of predictive value of digital brachial index (DBI) and transcutaneous oxygen tension (TCPO2).
• Discussion of treatment principles for DASS.

Main Results:

• A digital brachial index (DBI) >1 and transcutaneous oxygen tension (TCPO2) >60 mm Hg can rule out patients at risk for DASS.
• However, no specific DBI or TCPO2 thresholds below these values can accurately predict the development of dialysis-associated ischemia.
• Prompt diagnosis and intervention are key to successful management.

Conclusions:

• Vascular access surgeons must be adept at recognizing and treating DASS to preserve limb and access function.
• While certain objective measures can identify low-risk patients, predicting DASS development in others remains challenging.
• In most cases, continued use of angioaccess in the affected extremity is feasible after successful management of DASS.