Davidson Dion, Louridas George, Guzman Randolph, Tanner John, Weighell Wendy, Spelay Jodi, Chateau Dan
Division of Vascular Surgery, Department of Surgery, St. Boniface Hospital and University of Manitoba, Winnipeg, Man.
Can J Surg. 2003 Dec;46(6):408-12.
Steal syndrome is a potentially grave complication of upper extremity hemoaccess (HA) in patients with renal failure. To determine the incidence and risk factors for steal in these patients at the St. Boniface Hospital, Winnipeg, a tertiary care centre for vascular surgery and dialysis, we reviewed data from patients requiring hemodialysis between September 1986 and July 2000.
We excluded all venous catheter and lower extremity procedures. There remained 325 upper extremity procedures in 217 patients. Data were collected from the patients' charts or by interview. First by univariate analysis and then by multivariate analysis for independent risk factors, we studied the effect on the development of steal of age, sex, race diabetes mellitus, hypertension, coronary artery disease or cerebrovascular disease, smoking, proximal procedures based on the brachial artery, distal procedures based on the radial artery, the use of prosthetic graft material and the creation of autologous fistulas.
The incidence of steal was 6.2%. The significant independent risk factors were diabetes mellitus (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.39-18.08, p = 0.01) and Aboriginal race (OR 3.59, 95% CI 1.07-12.04, p = 0.04). An increasing risk for each year of advancing age at the time of procedure was suggested but was not significant (OR 1.04, 95% CI 1.00-1.09 p = 0.07).
Patients who are diabetic or Aboriginal are at increased risk for steal with upper extremity HA procedures. This knowledge can guide discussion of dialysis options and informed consent. If upper extremity HA procedures are undertaken in patients at risk, they should be closely monitored and early intervention applied if necessary.
窃血综合征是肾衰竭患者上肢血管通路（HA）的一种潜在严重并发症。为了确定温尼伯圣博尼费斯医院（一家血管外科和透析的三级护理中心）这些患者中窃血的发生率和危险因素，我们回顾了1986年9月至2000年7月期间需要血液透析患者的数据。
我们排除了所有静脉导管和下肢手术。217例患者中共有325例上肢手术。数据从患者病历中收集或通过访谈获取。首先通过单因素分析，然后通过多因素分析确定独立危险因素，我们研究了年龄、性别、种族、糖尿病、高血压、冠状动脉疾病或脑血管疾病、吸烟、基于肱动脉的近端手术、基于桡动脉的远端手术、人工血管材料的使用以及自体动静脉内瘘的建立对窃血发生的影响。
窃血发生率为6.2%。显著的独立危险因素是糖尿病（比值比[OR]5.00，95%置信区间[CI]1.39 - 18.08，p = 0.01）和原住民种族（OR 3.59，95% CI 1.07 - 12.04，p = 0.04）。手术时年龄每增加一岁，窃血风险有增加趋势，但不显著（OR 1.04，95% CI 1.00 - 1.09，p = 0.07）。
糖尿病患者或原住民患者进行上肢HA手术时发生窃血的风险增加。这一认识可指导透析方案的讨论和知情同意。如果对有风险的患者进行上肢HA手术，应密切监测，必要时进行早期干预。
