Division of Vascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Cardiovasc Intervent Radiol. 2023 Sep;46(9):1168-1181. doi: 10.1007/s00270-023-03462-6. Epub 2023 May 24.
Dialysis-associated steal syndrome (DASS) occurs in 1-8% of hemodialysis patients with arteriovenous (AV) access. Major risk factors include use of the brachial artery for access creation, female sex, diabetes, and age > 60 years. DASS carries severe patient morbidity including tissue or limb loss if not recognized and managed promptly, as well as increased mortality. Diagnosis of DASS requires a directed history and physical exam supported by non-invasive testing. Prior to definitive therapy, detailed arteriography, fistulography, and flow measurements are performed to delineate underlying etiologies and guide management. To optimize success, DASS treatment should be individualized according to access location, underlying vascular disease, flow dynamics, and provider expertise. Possible causes of DASS include extremity inflow or outflow arterial occlusive disease, high AV access flow rate, and reversal of distal extremity arterial blood flow; DASS may also exist without any of the prior features. Depending on the DASS etiology, various endovascular and/or surgical interventions should be considered. Regardless, in the majority of patients presenting with DASS, access preservation can be achieved.
透析相关窃血症（DASS）发生于 1%-8%的动静脉（AV）通路血液透析患者中。主要危险因素包括使用肱动脉建立通路、女性、糖尿病和年龄＞60 岁。如果不及时识别和处理，DASS 会导致严重的患者发病率，包括组织或肢体丧失，以及死亡率增加。DASS 的诊断需要有针对性的病史和体格检查，并辅以非侵入性检查。在进行确定性治疗之前，需要进行详细的血管造影、瘘管造影和流量测量，以明确潜在病因并指导治疗。为了优化治疗效果，应根据通路位置、潜在血管疾病、血流动力学和医生专业知识对 DASS 进行个体化治疗。DASS 的可能病因包括肢体流入或流出动脉阻塞性疾病、AV 通路高流量和远端肢体动脉血流逆转；DASS 也可能在没有任何先前特征的情况下存在。根据 DASS 的病因，应考虑各种血管内和/或手术干预措施。无论如何，在大多数出现 DASS 的患者中，都可以实现保留通路。
