Malik Jan, Slavikova Marcela, Maskova Jana
Third Department of Internal Medicine, General University Hospital, First Medical School of Charles University, Prague, Czech Republic.
J Nephrol. 2003 Nov-Dec;16(6):903-7.
Ischemic steal syndrome is an infrequent, but potentially disabling complication of hemodialysis (HD) access creation. We analyzed the ability of duplex Doppler ultrasonography to reveal potential causes of ischemic steal syndrome in antebrachial accesses.
We performed 212 examinations on 121 patients. Ten patients suffered from ischemic steal syndrome. Complete length access evaluation was performed by a linear array 7.5 MHz ultrasound probe.
Hand ischemia was explained by inflow artery stenosis in five cases. Excessive fistula flow due to large arteriovenous anastomosis was the suspected cause in two cases. The remaining two cases were characterized by high-resistant minimal flow in the ulnar artery with bi-directional flow in the distal part of the radial artery, suggesting stenoses located in the arcus palmaris. Duplex Doppler ultrasound had not revealed the etiology of clinically apparent hand ischemia in one case. Isolated inflow artery stenoses were treated successfully by percutaneous transluminal angioplasty. Patients with ischemic steal syndrome and high fistula flow were treated successfully by outflow vein banding.
Duplex Doppler ultrasonography is a valuable tool for diagnosing the cause of ischemic steal syndrome and can probably replace angiography in some cases.
缺血性窃血综合征是血液透析（HD）通路建立过程中一种罕见但可能致残的并发症。我们分析了双功多普勒超声检查揭示前臂通路缺血性窃血综合征潜在病因的能力。
我们对121例患者进行了212次检查。10例患者患有缺血性窃血综合征。使用7.5MHz线性阵列超声探头对整个通路进行评估。
5例患者手部缺血是由流入动脉狭窄所致。2例患者怀疑是由于大的动静脉吻合导致瘘管血流量过大。其余2例患者的特征是尺动脉高阻力低血流量，桡动脉远端双向血流，提示掌弓处存在狭窄。双功多普勒超声未揭示1例临床上明显手部缺血的病因。孤立的流入动脉狭窄经皮腔内血管成形术治疗成功。缺血性窃血综合征且瘘管血流量高的患者经流出静脉绑扎治疗成功。
双功多普勒超声是诊断缺血性窃血综合征病因的重要工具，在某些情况下可能替代血管造影。
