%0 Journal Article
%T Volume Flow Measurements in Arteriovenous Dialysis Access in Patients with and without Steal Syndrome
%A Charudatta S. Bavare
%A Jean Bismuth
%A Hosam F. El-Sayed
%A Tam T. Huynh
%A Eric K. Peden
%A Mark G. Davies
%A Alan B. Lumsden
%A Joseph J. Naoum
%J International Journal of Vascular Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/328601
%X Introduction. Dialysis associated steal syndrome (DASS) constitutes a serious risk for patients undergoing vascular access operations. We aim to assess the measured volume flow using ultrasound in patients with clinically suspected steal syndrome and determine differences in flow among types of arteriovenous (AV) access. Methods. Patients with permanent hemodialysis access with and without ischemic steal underwent duplex ultrasound (US) exams for the assessment of volume flow and quantitative evidence of hemodynamic steal. Volume flow was measured in the proximal feeding artery. Results. 118 patients underwent US of which 82 (69.5%) had clinical evidence of steal. Women were more likely to develop steal compared to men (chi-squared test ). Mean volume flow in patients with steal was 1542£żmL/min compared to 1087£żmL/min ( ) in patients without evidence of steal. A significant difference in flow volumes in patients with and without steal was only seen in patients with a brachial-cephalic upper arm AV fistula (AVF) ( ). When comparing different types of access with steal, brachial-cephalic upper arm AVFs had higher volume flows than the upper extremity AV graft (AVG) group ( ). Conclusion. In patients with DASS, women were more likely to develop steal syndrome. Significantly higher volume flows were seen with brachial-cephalic upper arm AVF in patients with steal compared to those without. A physiologic basis of this US finding may be present, which warrants further study into the dynamics of flow and its relationship to the underlying peripheral arterial pathology in the development of ischemic steal. 1. Introduction Creating and maintaining a functional hemodialysis access conduit is challenging. With an increasing number of patients needing hemodialysis per year, the demand for a durable access with minimum complications is also increasing. Among the postoperative complications, dialysis associated steal syndrome (DASS) is the most morbid, often resulting in significant neurologic injury or tissue loss. Clinical risk factors previously identified in patients at risk for development of DASS include age greater than 60 years, female gender, diabetes, previous limb procedures, and type of fistula constructed [1¨C5]. DASS is a relatively uncommon phenomenon, occurring in 1%¨C10% of cases [3]. There are no reliable methods of predicting its development, and management is challenging. Preservation of the existing access and relief of the ischemia are a priority in the treatment of DASS. Bussell and associates described DASS in patients with a radial-cephalic
%U http://www.hindawi.com/journals/ijvm/2013/328601/