Recognition and treatment of vascular steal secondary to hemodialysis prostheses

Ischemic symptoms of the distal extremity developed in 4 patients from a group of 55 in whom a primary polytetrafluorethylene prosthesis was placed for purpose of hemodialysis. Diagnosis of vascular steal syndrome was suggested by clinical symptoms of pain and coolness of the distal part, as well as trophic changes of the hand. The diagnosis was confirmed by placing a cuffed photoplethysmograph transducer on one or more of the digits of the affected limb and recording the waveform before and during manual compression of the arterial end of the prosthesis. The findings showed essentially a flat waveform converting to pulsatile waveform when the proximal graft was compressed. Two patients underwent controlled operative banding of the arterial end of the polytetrafluoroethylene prosthesis using this same method. A polytetrafluoroethylene cardiovascular patch was cut to a width of 1 cm and then cut again to form two shoelace tails each 0.5 cm in width. The band was placed around the proximal part of the prosthesis and progressively tightened until an adequate digital pulse wave returned. Preservation of flow through the prosthesis was maintained so as to allow dialysis and prevent thrombosis. The technical aspects of the procedure have been discussed. Vascular steal syndrome appears to be more common in the diabetic.