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In hemodialysis, steal syndrome is a condition of ischemia in the territory distal to an AVF.
There are different interpretations, as causes, it may be caused by arterial disease secondary to atherosclerosis, or inversion of the flow of the distal arterial territory to the arterial mouth of the AVF causing ischemia and hence the so-called steal of distal arterial flow.
The risk factors are native AVF, the most common in our series being brachycephalic AVF, less frequent secondary to AVF with synthetic prosthesis,
Other factors are diabetes, smoking, advanced age.
The symptoms may be chronic pain or when the patient is dialyzed, or there may be chronic tissue lesions.
These patients must be properly studied to rule out ischemia due to arterial disease.
When there are many surgical techniques for a pathology, it means that none of them are as good.
For this phenomenon of steal syndrome, numerous surgical techniques have been described.
The presentations of AVF with steal syndrome that we had were:
4 brachio-axillary prostheses
34 brachycephalic
7 transpositions of basilicas
We choose to use several techniques,
5 patients with reduction of the caliber of the vein with PTFE of 6 mm diameter by 3 mm long, at the venous end of the arterial anastomosis
2 patients we closed the AVF directly, at the patient's request
3 patients with native AVF performed the RUDI procedure
17 patients we did reduction of the anastomosis or juxta-anastomotic stenosis with prolene ligation in the graft
18 patients we ligated the distal brachial artery to the AVF anastomosis
We show that we prefer these last 2 techniques, due to their simplicity and good results, which also do not require catheter implantation.
The technique of ligation of the brachial artery we have to preferably rule out by arteriography that there is no disease in the brachial artery.
With a small incision, we approach the arterial anastomosis, and place a clamp distal to the anastomosis. If the pulse wave recorded by the oximeter appears or improves, and the patient feels relief, this is when we proceed to perform a double ligation of the artery.
We believe that in this way we interrupt the reverse arterial flow, that is, we interrupt the steal syndrome.
With 12-month follow-up
1 patient with the RUDI procedure had 3 fingers amputated 72 hours after surgery.
1 patient with brachial artery ligation had 4 fingers amputated 1 month after surgery
1 patient with brachial artery ligation continued to have pain and the AVF was closed
The rest of the patients had a good evolution
With the different known techniques, we do not find brachial artery ligation described in this way.
We do it with the objective that we described before to interrupt the phenomenon of reverse arterial flow.
We believe that it is a good, simple and effective alternative.