Steal syndrome—strategies to preserve vascular access and extremity

Extract

Introduction

In access-related steal syndrome, four stages can be distinguished (Table 1, [1]). Steal syndrome stage I (retrograde inflow of blood into the access during diastole without complaints) is a frequent finding in arteriovenous (AV) fistulae and grafts [2] and needs no intervention. Patients with pain on exercise or during dialysis (stage II), however, require permanent attention in order to early detect deterioration to stage III (rest pain) or stage IV (necrosis).

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Depending on the type and location of AV access for HD, the risk of severe access-related peripheral ischaemia (steal syndrome stage III or IV) varies between 1–2% (in distal radio-cephalic AV fistulae) and 5–15% (in brachio-cephalic/basilic fistulae and grafts) [3–6]. Following the creation of a femoral (autogenous or allograft) access, an even higher incidence of steal syndrome (16 to 36%, [7,8]) has been reported. Women, diabetics and patients with known coronary or peripheral arterial occlusive disease are at higher risk than the remaining HD population [3,9–11].