Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
J Vasc Surg. 2011 Aug;54(2):554-8. doi: 10.1016/j.jvs.2011.01.031. Epub 2011 Mar 31.
Establishing a functional vascular access while minimizing the risk of dialysis access-associated ischemic steal syndrome (DASS) may present a challenging problem in patients with severe peripheral vascular disease where even a low-flow arteriovenous fistula (AVF) may lead to severe symptoms and physical findings of DASS. Proximalization of arterial inflow for an existing vascular access is established as an effective treatment for DASS. We hypothesized that a primary proximal arterial inflow procedure for vascular access in patients judged to be at high risk for DASS would result in a successful hemodialysis access and mitigate the risk of steal syndrome. We report four such patients considered to be at significant risk for DASS after construction of a new vascular access. An axillary artery AVF inflow anastomosis was constructed in each patient. The access outflow configuration varied with the available venous outflow conduit identified during the preoperative ultrasound evaluation. In all four patients in this report, a functional autogenous dialysis access was established without DASS.
在建立功能性血管通路的同时，最大限度地降低透析通路相关缺血性窃血综合征（DASS）的风险，对于严重外周血管疾病患者来说可能是一个具有挑战性的问题，因为即使是低流量动静脉瘘（AVF）也可能导致 DASS 的严重症状和体征。现有血管通路的动脉流入近端化已被确立为 DASS 的有效治疗方法。我们假设，对于被认为有发生 DASS 高风险的患者，进行主要的近端动脉流入手术来建立血管通路，将导致成功的血液透析通路，并降低窃血综合征的风险。我们报告了 4 例新血管通路建立后被认为存在 DASS 高风险的患者。在每位患者中，都构建了腋动脉 AVF 流入吻合术。通路的流出配置随术前超声评估中确定的可用静脉流出导管而变化。在本报告的所有 4 例患者中，均建立了功能良好的自体透析通路，且无 DASS 发生。
