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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1998 August;39(4):441-3

lingua: Inglese

Sur­gical treat­ment of “­steal syn­drome” induced by arter­i­ov­e­nous ­grafts for hemo­di­al­ysis

Stierli P., Blumberg A.*, Pfister J., Zehnder C.*

From the Depart­ment of Sur­gery and * Divi­sion of Neph­rology, Kan­tons­spital, Aarau, Switzerland


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Objec­tive. A ­rare but ­serious com­pli­ca­tion of angioac­cess sur­gery for hemo­di­al­ysis is the so ­called ­steal syn­drome pre­senting as ­ischemia ­distal to an arter­i­ov­e­nous fis­tula. The ­main ­problem of var­ious sur­gical tech­niques to cor­rect ­steal is sub­se­quent throm­bosis of the fis­tula or per­sis­tence of ­distal ­ischemia.
Inter­ven­tions. ­This ­paper ­describes an ­unknown tech­nique for cor­rec­tion of ­ischemic ­steal con­sisting of liga­tion of the ­artery ­just ­distal to the ­take-off of the fis­tula and arte­rial ­bypass ­from the ­artery prox­imal to the ­take-off of the fis­tula to the ­artery ­distal to liga­tion.
­Patients. Six ­patients ­with ­chronic ­renal insuf­fi­ciency (3 ­male, 3 ­female) with ­patent ­upper arm ­cephalic fis­tulas pre­sented ­with ­severe ­hand ­ischemia.
­Results. Symp­toms ­improved in all 6 ­patients imme­di­ately ­after oper­a­tion. Suc­cessful hemo­di­al­ysis ­could be main­tained ­using the orig­inal fis­tula.
Con­clu­sions. The ­described tech­nique is ­maybe the pro­ce­dure of ­choice for the cor­rec­tion of fis­tula ­induced ­ischemic ­steal.

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