Indications for Surgical Treatment of Angioaccess-Induced Arterial 'steal'
| Autor: | M K, Lazarides, D N, Staramos, G N, Panagopoulos, V D, Tzilalis, G J, Eleftheriou, J N, Dayantas, D N, Staamos |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
medicine.medical_specialty
Fistula medicine.medical_treatment Neural Conduction Ischemia Blood Pressure Physical examination Arteriovenous Shunt Surgical Forearm medicine.artery medicine Humans Prospective Studies Brachial artery Ligature Retrospective Studies medicine.diagnostic_test business.industry Vascular disease medicine.disease Surgery body regions Treatment Outcome Blood pressure medicine.anatomical_structure Arm business |
| Zdroj: | Journal of the American College of Surgeons. 187:422-426 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/s1072-7515(98)00139-2 |
| Popis: | Arterial "steal" is a well-known complication following proximal arteriovenous (AV) fistula, but its manifestations comprise a wide spectrum of symptoms and there are no clear indications for those patients who need surgical repair.Among 180 consecutive AV fistulas of various configurations, with the brachial artery as the donor artery in all patients, 111 patients were studied retrospectively (group A) and 69 patients were studied prospectively (group B). Patient records were reviewed in group A, and the decision for surgical correction of limb-threatening steal was based on clinical grounds only. In group B, all patients were followed prospectively; postoperative systolic blood pressure measurements were obtained, and a systolic pressure index (SPI) was calculated (postoperative forearm systolic pressure divided by contralateral forearm systolic pressure). In patients with an SPI0.6, nerve conduction studies (NCS) were performed. The decision for operation in this group was based on clinical examination, SPI, and NCS.Seven patients were operated on for steal-induced limb-threatening ischemia; in all seven patients, ischemia developed immediately after access construction. One additional patient with mild symptoms and deterioration in repeated NCS was considered a candidate for ischemic monomelic neuropathy and was successfully operated on 1 month later. The ligation-bypass technique was used in all patients, consisting of arterial ligature distal to the takeoff of the graft and short arterial bypass from a point proximal to the inflow of the access to a point just distal to ligation. In 94% of the patients, some degree of distal ischemia was detected (SPI0.8); patients with SPI0.5 were most likely to have impaired NCS.Steal-induced limb-threatening ischemia necessitating immediate surgical repair occurred in 3.9% (7 of 180) of our patients. The decision for surgical correction of steal should be based on clinical examination. Nerve conduction studies may be useful in patients who have an SPI value0.5 to detect candidates who might develop ischemic monomelic neuropathy. In similar patients, surgical treatment of steal should be offered. |
| Databáze: | OpenAIRE |
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