Raml Nancy M
Department of Vascular Surgery, Zablocki VA Medical Center and Marquette University College of Nursing, Milwaukee, Wisconsin 53295, USA.
J Vasc Nurs. 2012 Sep;30(3):94-7. doi: 10.1016/j.jvn.2012.02.001.
Arteriovenous fistulas may be susceptible to steal syndrome from a variety of conditions. Steal syndrome is defined as arterial insufficiency distal to the arteriovenous fistula. The causality of the insufficiency may include arterial disease proximal or distal to the fistula, markedly high blood flow volume after creation, or undetected collateral flow. Prior arterial disease may expose insufficient profusion to the distal extremity after fistula creation. High blood flow volume immediately after fistula creation may perhaps cause steal syndrome symptoms, but this often resolves with fistula maturation. Undetected collateral flow, or side branches, from target vessels receive increased blood volume after fistula creation and expand, thereby stealing blood flow from the hand. This particular condition can potentially cause ischemic changes distal to the fistula with potentially irreversible sequela if not recognized in a timely manner. A sixty- one year old male, sent with chest pain to the emergency room from his dialysis center, was found to have steal syndrome with an accompanying motor deficit. The diagnosis of steal syndrome is based on physical examination, patient history, and confirmation testing such as doppler ultrasound, digital pressures or arteriogram. A thorough preoperative workup and careful postoperative monitoring can minimize steal syndrome and prevent permanent impairment.
动静脉瘘可能因多种情况而易患窃血综合征。窃血综合征定义为动静脉瘘远端的动脉供血不足。供血不足的原因可能包括瘘管近端或远端的动脉疾病、造瘘后明显高的血流量，或未检测到的侧支血流。既往动脉疾病可能导致造瘘后远端肢体供血不足。造瘘后立即出现的高血流量可能会引发窃血综合征症状，但这种情况通常会随着瘘管成熟而缓解。造瘘后，来自靶血管未被检测到的侧支血流或侧支会接受增加的血容量并扩张，从而从手部窃取血流。如果不及时识别，这种特殊情况可能会在瘘管远端导致缺血性改变，并可能产生不可逆转的后遗症。一名61岁男性从透析中心被送往急诊室，胸痛，被发现患有窃血综合征并伴有运动功能障碍。窃血综合征的诊断基于体格检查、患者病史以及诸如多普勒超声、指压或动脉造影等确诊检查。全面的术前检查和仔细的术后监测可以将窃血综合征的发生降至最低，并防止永久性损伤。
