Arterial Steal Syndrome: A Modest Proposal for an Old Paradigm

Slides:

Advertisements

Similar presentations

Patient has a radiocephalic fistula in his right forearm right elbow blood flow anastomosis.

Advertisements

Peter Gloviczki, MD, Peter C. Pairolero, MD, Barbara J

Renal Function Testing

JEFFREY W. FRANK, M. D. , PATRICK S. KAMATH, M. D. , ANTHONY W

Epistaxis as a Rare Complication of Catheter-Related Central Venous Stenosis Jin-Ju Tsai, MD, Ching-Chih Hsia, MD, Dong-Ming Tsai, MD, Wei-Tsung Chen,

Peritoneal dialysis American Journal of Kidney Diseases

Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis Bertrand Long, MD, Nicolas Brichart,

Clinical Practice Guidelines for Vascular Access

Annie Wang, MD, James E. Silberzweig, MD

Low-dose direct fibrinolysis in peripheral vascular disease

Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis John Swinnen, MBChB, FRACS (General),

Hypertension in the hemodialysis patient and the “lag phenomenon”: insights into pathophysiology and clinical management Uday M Khosla, MD, Richard J.

Vascular Access: Core Curriculum 2008

Lucien E. M. Duijm, MD, PhD, Ylian S. Liem, MD, Rob H. H

Peripherally Inserted Central Catheters and Other Intravascular Devices: How Safe Are They for Hemodialysis Patients? Roman Shingarev, MD, Michael Allon,

Daniel R. Gorin, MD, FACS, Lisa Perrino, RDMS, RVT, Donna M

Diagnostic Pitfalls in Atypical Coronary-subclavian Steal Syndrome

Quiz Page May 2011 American Journal of Kidney Diseases

A novel technique of vascular anastomosis to prevent juxta-anastomotic stenosis following arteriovenous fistula creation Ankit Bharat, MD, Mathew Jaenicke,

Unequal Blood Pressures: A Manifestation of Subclavian Steal

Vascular Access: Core Curriculum 2008

Use of the distal radial artery remnant for autogenous radial-cephalic wrist fistula after radial artery harvest for coronary artery bypass grafting

Hemodialysis Arteriovenous Fistula Created From the Posterior Tibial Artery and a Saphenous Vein Branch Taiga Hara, MD, PhD, Tadashi Sofue, MD, PhD,

Peter A. McCullough, MD, MPH Advances in Chronic Kidney Disease

Primary arteriovenous fistula inflow proximalization for patients at high risk for dialysis access-associated ischemic steal syndrome William C. Jennings,

Low-flow maturation failure of distal accesses: Treatment by angioplasty of forearm arteries Alain Raynaud, MD, Luigi Novelli, MD, Pierre Bourquelot,

Salt and Hypertension American Journal of Kidney Diseases

Ryan A. Helmick, MD, Charles L. Mesh, MD Journal of Vascular Surgery

Is There Any Reason to Stent Atherosclerotic Renal Artery Stenosis?

Aneurysmal degeneration of the donor artery after vascular access

Tumescent anesthesia reduces pain associated with balloon angioplasty of hemodialysis fistulas Wen-Yu V. Haines, MD, Ryan Deets, BS, Ning Lu, BS, John.

Stenosis detection in failing hemodialysis access fistulas and grafts: Comparison of color Doppler ultrasonography, contrast-enhanced magnetic resonance.

Hemoglobin Level and Transfusions in Patients on Maintenance Dialysis: Where the Rubber Meets the Road Eduardo Lacson, MD, MPH, Franklin Maddux, MD

Reconstruction of the superior vena cava: Benefits of postoperative surveillance and secondary endovascular interventions Yves S. Alimi, MD, Peter Gloviczki,

Outpatient treatment of arterial inflow stenoses of dysfunctional hemodialysis access fistulas by retrograde venous access puncture and catheterization

Internal jugular to axillary vein bypass for subclavian vein thrombosis in the setting of brachial arteriovenous fistula John D. Puskas, MD, Jonathan.

Daniel R. Gorin, MD, FACS, Lisa Perrino, RDMS, RVT, Donna M

Hypertension in the hemodialysis patient and the “lag phenomenon”: insights into pathophysiology and clinical management Uday M Khosla, MD, Richard J.

Use of the distal radial artery remnant for autogenous radial-cephalic wrist fistula after radial artery harvest for coronary artery bypass grafting

Volume 67, Issue 5, Pages (May 2005)

Flow reduction in high-flow arteriovenous access using intraoperative flow monitoring Juergen Zanow, MD, Karen Petzold, MD, Michael Petzold, MD, Ulf Krueger,

Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: A previously undescribed complication of dialysis access W.G. Schenk,

Duplex-guided balloon angioplasty of failing or nonmaturing arterio-venous fistulae for hemodialysis: A new office-based procedure Enrico Ascher, MD,

Study Designs in Patient-Oriented Research

Traumatic arteriovenous fistula 52 years after injury

Banding between dialysis puncture sites to treat severe ischemic steal syndrome in low flow autogenous arteriovenous access David Shemesh, MD, Ilya Goldin,

Roel H. D. Vaes, MD, Jan H. Tordoir, MD, PhD, Marc R

Prevention of vascular access hand ischemia using the axillary artery as inflow William Jennings, MD, Robert Brown, MD, John Blebea, MD, MBA, Kevin Taubman,

Distal revascularization and interval ligation procedure for radial-basilic forearm transposition arteriovenous fistula Babatunde H. Almaroof, MD, Jonathan.

Linda Le, MD, Ashton Brooks, MBBS, Melissa Donovan, MD, Taylor A

Low-dose direct fibrinolysis in peripheral vascular disease

Geoffrey H. White, M. D. , Rodney A. White, M. D. , George E

Miltos K. Lazarides, MD, Spyros N

Diagnosis and salvage of an immature fistula

Arteriovenous fistula creation: should US nephrologists get involved?

Arteriography in a patient with symptoms of arterial steal syndrome.

Jordi Goldstein-Fuchs, DSc, RD, RN, Denis Fouque, MD, PhD

Role of glucocorticoids in acidosis

Quiz Page Answers July 2006 American Journal of Kidney Diseases

Regarding “Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas.

F.-M. Wang, W.-C. Tseng, Y.-Y. Hsieh, D.-C. Tarng

Scott S. Berman, MD, FACS, Andrew T. Gentile, MD

Critical hand ischemia caused by forearm fibromuscular dysplasia

Ioannis Prionidis, MD, Tom F. Browne Journal of Vascular Surgery

Clinical Practice Recommendations For Peritoneal Dialysis Adequacy

Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome N. Goel, G.A. Miller,

Vascular access for hemodialysis

Volume 67, Issue 6, Pages (June 2005)

Why don't fistulas mature?

Clinical Practice Guidelines for Peritoneal Dialysis Adequacy

Presentation transcript:

Arterial Steal Syndrome: A Modest Proposal for an Old Paradigm Arif Asif, MD, Carlos Leon, MD, Donna Merrill, RN, Bhagwan Bhimani, MD, Renee Ellis, MD, Marco Ladino, MD, Florin N. Gadalean, MD American Journal of Kidney Diseases Volume 48, Issue 1, Pages 88-97 (July 2006) DOI: 10.1053/j.ajkd.2006.03.077 Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 1 Results of arteriography in 12 consecutive patients undergoing arteriography. *Two patients with arterial stenosis were referred for surgical intervention. American Journal of Kidney Diseases 2006 48, 88-97DOI: (10.1053/j.ajkd.2006.03.077) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 2 (A) An axillary artery stenosis (70%). (B) Successful dilatation of the stenotic lesion after balloon angioplasty with resolution of symptoms of steal syndrome. American Journal of Kidney Diseases 2006 48, 88-97DOI: (10.1053/j.ajkd.2006.03.077) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 3 Brachiocephalic fistula with (A) critical stenosis of the brachial artery in the anastomotic area and (B) successful angioplasty of the lesion. American Journal of Kidney Diseases 2006 48, 88-97DOI: (10.1053/j.ajkd.2006.03.077) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 4 (A) A patient with a brachial artery (arrow) to cephalic vein fistula with symptoms of arterial steal. Retrograde flow into the fistula was seen through the distal portion of the brachial artery. No flow distally past the arrowhead was seen on angiography. (B, C) Upon occlusion, antegrade flow was established into the forearm arteries (arrows). American Journal of Kidney Diseases 2006 48, 88-97DOI: (10.1053/j.ajkd.2006.03.077) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 5 (A-F) Arteriography in a patient with symptoms of arterial steal syndrome. Arrows indicate the direction of blood flow. Bold arrow (short) indicates 60% stenosis of the artery just proximal to the anastomosis. Bold arrow (long) shows a juxta-anastomotic venous stenosis. Even this stenosis was not able to protect the patient against steal syndrome. Retrograde flow was noted through the radial artery into the access. Physical examination could confirm the retrograde filling of the radial artery by occluding the ulnar artery and performing palpation of the radial artery. The patient showed a good radial artery on physical examination. This case required an axillary loop fistula using the outflow of the existing fistula. Abbreviations: RA, radial artery; UA, ulnar artery; CVAVF, cephalic vein arteriovenous fistula. American Journal of Kidney Diseases 2006 48, 88-97DOI: (10.1053/j.ajkd.2006.03.077) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 6 A simple algorithm to manage patients with symptoms of arterial steal. American Journal of Kidney Diseases 2006 48, 88-97DOI: (10.1053/j.ajkd.2006.03.077) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 7 A patient with a radiocephalic fistula. (A) Arrows indicate vascular calcification of forearm arteries. (B) The brachial artery of the same patient also shows calcification. Anastomosis (double arrow), imaging catheter into the fistula (arrowhead). American Journal of Kidney Diseases 2006 48, 88-97DOI: (10.1053/j.ajkd.2006.03.077) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions