Bavare Charudatta S, Bismuth Jean, El-Sayed Hosam F, Huynh Tam T, Peden Eric K, Davies Mark G, Lumsden Alan B, Naoum Joseph J
Department of Cardiovascular Surgery, The Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, 6550 Fannin Street, Suite 1401 Houston, TX 77030, USA.
Int J Vasc Med. 2013;2013:328601. doi: 10.1155/2013/328601. Epub 2013 Aug 27.
Introduction. Dialysis associated steal syndrome (DASS) constitutes a serious risk for patients undergoing vascular access operations. We aim to assess the measured volume flow using ultrasound in patients with clinically suspected steal syndrome and determine differences in flow among types of arteriovenous (AV) access. Methods. Patients with permanent hemodialysis access with and without ischemic steal underwent duplex ultrasound (US) exams for the assessment of volume flow and quantitative evidence of hemodynamic steal. Volume flow was measured in the proximal feeding artery. Results. 118 patients underwent US of which 82 (69.5%) had clinical evidence of steal. Women were more likely to develop steal compared to men (chi-squared test P < 0.04). Mean volume flow in patients with steal was 1542 mL/min compared to 1087 mL/min (P < 0.002) in patients without evidence of steal. A significant difference in flow volumes in patients with and without steal was only seen in patients with a brachial-cephalic upper arm AV fistula (AVF) (P < 0.002). When comparing different types of access with steal, brachial-cephalic upper arm AVFs had higher volume flows than the upper extremity AV graft (AVG) group (P = 0.04). Conclusion. In patients with DASS, women were more likely to develop steal syndrome. Significantly higher volume flows were seen with brachial-cephalic upper arm AVF in patients with steal compared to those without. A physiologic basis of this US finding may be present, which warrants further study into the dynamics of flow and its relationship to the underlying peripheral arterial pathology in the development of ischemic steal.
引言。透析相关盗血综合征（DASS）是接受血管通路手术患者面临的严重风险。我们旨在评估临床疑似盗血综合征患者使用超声测量的血流量，并确定动静脉（AV）通路类型之间的血流差异。方法。对有或无缺血性盗血的永久性血液透析通路患者进行双功超声（US）检查，以评估血流量和血流动力学盗血的定量证据。在近端供血动脉测量血流量。结果。118例患者接受了超声检查，其中82例（69.5%）有盗血的临床证据。女性比男性更易发生盗血（卡方检验P<0.04）。有盗血患者的平均血流量为1542 mL/min，无盗血证据患者为1087 mL/min（P<0.002）。有和无盗血患者的血流量差异仅在肱头型上臂动静脉内瘘（AVF）患者中可见（P<0.002）。比较有盗血的不同类型通路时，肱头型上臂AVF的血流量高于上肢动静脉移植物（AVG）组（P=0.04）。结论。在DASS患者中，女性更易发生盗血综合征。与无盗血患者相比，有盗血的肱头型上臂AVF患者的血流量明显更高。这一超声检查结果可能存在生理基础，这值得进一步研究血流动力学及其与缺血性盗血发生时潜在外周动脉病变的关系。
