Treatment of vascular access-related steal syndrome by means of juxta-anastomotic vein interposition of a prosthetic graft segment

Abstract

Objective: Steal syndrome is a severe complication of vascular access. Our aim is to present the initial results of a simple and effective treatment: the interposition of a prosthetic segment in the juxta-anastomotic vein. Method: Between 2009 and 2012, 14 patients (57 % male, average age 71) with severe steal syndrome due to native vascular access (stages II-IV), following a clinical and systematic echographic study and a selective angiographic study, were treated through the interposition of a 6 mm diameter tubular graft segment (PTFE) in the juxta-anastomotic vein, in addition to selective patch repair of arterial stenosis (2 cases) or ligature of useless venous collaterals (8 cases). Local or regional anaesthesia was used and outpatient care was given in all cases. Results: There was 100 % technical success. The pre- and post-operative echographical study showed a reduction of post-operative access flow by 39 % and an increase of radial artery flow by 477 %. Ischaemic symptoms were resolved in 12 patients (86 %); the other two patients required additional procedures due to persistent ischaemic symptoms. There was a post-operative venous rupture, which required a definitive ligation. No patient suffered amputations, nor were there losses or access thrombosis during the follow-up. The primary and primaryassisted patencies free of new ischemic symptoms were 78 % and 78 % at 12 months, and 62 % and 78 % at 24 months. Conclusions: The interposition of a prosthetic segment in the juxta-anastomotic vein is a simple, quick and effective technique in the treatment of vascular steal syndrome, with promising results at the 2 year follow-up.