Clinical Challenges in Vascular Surgery: Dialysis Associated Steal Syndrome

In this episode of Behind the Knife the vascular surgery subspecialty team discusses a few case scenarios of patients with dialysis associated hand ischemia (or steal syndrome). Although a rare, steal syndrome can be detrimental to patients with end stage renal disease and result in not only risk of losing dialysis access but even their limb. What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, and what options you have to fix it.

Hosts:
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.
Dr. David Schectman is a Vascular Surgery Fellow at the University of Michigan
Dr. Drew Braet is a PGY-4 Integrated Vascular Surgery Resident at the University of Michigan

Learning Objectives
- Review high-yield topics regarding hemodialysis access
- Understand the incidence of and the relevant risk factors for dialysis associated steal syndrome
- Review the spectrum of presenting symptoms and relevant workup for dialysis associated steal syndrome
- Understand surgical treatment options for dialysis associated steal syndrome

References
Please review the journal article below for helpful pictures and depictions of the operations we describe in this episode.
- Al Shakarchi J, et al. Surgical techniques for haemodialysis access-induced distal ischaemia. J Vasc Access. 2016 Jan-Feb;17(1):40-6.
https://pubmed.ncbi.nlm.nih.gov/26349875/

Other helpful references
- Kordzadeh A, Parsa AD. A Systematic review of distal revascularization and interval ligation for the treatment of vascular access-induced ischemia. J Vasc Surg 2019; 70:1364.
https://pubmed.ncbi.nlm.nih.gov/31153703/
- Huber TS, Larive B, Imprey PB, et al. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg 2016;64:1050.
https://pubmed.ncbi.nlm.nih.gov/27478007/
- Sidawy An, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48:2S.
https://pubmed.ncbi.nlm.nih.gov/19000589/

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