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Dialysis-associated steal syndromes.

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Dialysis access steal syndrome (DASS) affects 4-10% of patients. Management involves clinical diagnosis, risk factor identification, and surgical or interventional correction for fistula preservation.

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Interventional Radiology

Background:

  • Dialysis access steal syndrome (DASS) is a complication of hemodialysis access creation.
  • It involves ischemia of the extremity distal to the access.
  • Understanding its pathophysiology and risk factors is crucial for management.

Purpose of the Study:

  • To review contemporary concepts in the genesis of Dialysis Access Steal Syndrome (DASS).
  • To summarize current diagnostic and management strategies for DASS.
  • To provide an overview of risk factors and pathophysiology.

Main Methods:

  • Systematic literature search of PubMed and Cochrane Library (1960-2020).
  • Inclusion of practice guidelines related to dialysis access.
  • Review of clinical presentation, pathophysiology, risk factors, diagnostics, and management outcomes.

Main Results:

  • Symptomatic DASS occurs in 4-10% of patients post-hemodialysis access creation.
  • Key risk factors include brachial-based fistulas, diabetes, female sex, cardiovascular disease, tobacco use, age >60, and hypertension.
  • Diagnosis is primarily clinical, supported by non-invasive testing when uncertain.

Conclusions:

  • DASS has complex hemodynamic causes and presents with extremity ischemia.
  • Management strategies focus on fistula preservation through correction of inflow stenosis or revascularization techniques.
  • Treatment decisions are individualized based on anatomical, patient, and disease-related factors.