Difference between revisions of "Vascular insufficiency from AV fistula"
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Revision as of 14:42, 18 October 2015
- Steal syndrome = Distal hypoperfusion ischemic syndrome
- Higher risk with more proximal fistulas
- 10–25% of brachiocephalic and basilic artery fistulas
- 4.3–6% of forearm prosthetic implants
- 1–1.8% of radiocephalic fistulas
- Classically elderly woman with DM
- Patietn history may include revascularization or banding efforts that re-stenose
- Distal extremity becomes ischemic due shunting of arterial blood to venous side
- Exercise pain, nonhealing ulcers, cool, pulseless digits
- 4 Stages
- Stage I: pale/blue and/or cold hand without pain
- Stage II: pain during exercise and/or hemodialysis
- Stage III: rest pain
- Stage IV: ulcers/necrosis/gangrene
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
- Initial diagnosis is clinical
- Confirmation by:
- Digital blood pressure measurement
- Duplex ultrasonography
- Transcutaneous PO2 measurement
- Percutaneous transluminal angioplasty (PTA)
- *Malik et Al. Understanding the dialysis access steal syndrome. A review of the etiologies, diagnosis, prevention and treatment strategies. J Vasc Access. 2008 Jul-Sep;9(3):155-66.
- Tordoir JHM, et al. Upper extremity ischemia and hemodialysis vascular access. European journal of vascular and endovascular surgery. 2004. 27(1):1-5.
- Rutherford RB. The value of noninvasive testing before and after hemodialysis access in the prevention and management of complications. Semin Vasc Surg. 1997; 10:157–161.