Download PDF
Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2015; 02(04): 323-338
DOI: 10.1055/s-0034-1393284
Fortbildung
AV-Dialysezugänge
© Georg Thieme Verlag KG Stuttgart · New York

Shunt-induzierte Handischämie

Farzin Adili
,
Richard Kellersmann
Further Information

Publication History

Publication Date:
28 October 2015 (online)

Also available at
    Permissions and Reprints
Fazit und Ausblick

Die Therapie der Shunt-induzierten Handischämie wird zukünftig eine zunehmende Bedeutung erfahren. Der Anstieg der Anzahl älterer Hämodialysepatienten mit einem höheren Anteil an Diabetikern wird vermehrt Patienten mit Risikofaktoren für eine Shunt-induzierte Handischämie bedingen (proximal gelegene Anastomose, vorbestehende Gefäßveränderungen). Einheitliche Empfehlungen zur Wahl des Behandlungsverfahrens können nicht gegeben werden. Auch die DRIL-Prozedur, die oftmals in der neueren Literatur als Standardverfahren propagiert wird, ist nur Teil eines Armamentariums der Therapie der Shunt-induzierten Handischämie. Entscheidend für die Wahl des Therapieverfahrens ist das Erkennen der individuell bei den einzelnen Patienten zugrunde liegenden Pathomechanismen der Shunt-induzierten Handischämie. Faktoren wie die geschätzte Lebenserwartung des Patienten und die Beeinflussung der Lebensqualität durch das Operationsverfahren sollten bei der Indikationsstellung Berücksichtigung finden. Technische Weiterentwicklungen bei der Identifizierung und Überwachung der hämodynamischen Veränderungen nach Anlage eines arteriovenösen Shunt werden das Verständnis der Ätiologie der Shunt-induzierten Handischämie erweitern, die differenzierte Verfahrenswahl zur Therapie der Shunt-induzierten Handischämie unterstützen und den zu erwartenden Einfluss auf die Symptombeseitigung und den Shunt-Erhalt besser abschätzen lassen. Sicherlich gehört die Behandlung der Shunt-induzierten Handischämie in die Hand des erfahrenen Shunt-Chirurgen, da die Qualität der von ihm durchgeführten Maßnahmen das Outcome des Hämodialysepatienten wesentlich beeinflussen kann.

 

  • Literatur

  • 1 Papasavas PK, Reifsnyder T, Birdas TJ et al. Prediction of arteriovenous access steal syndrome utilizing digital pressure measurements. Vasc Endovascular Surg 2003; 37: 179-184
    CrossrefGoogle Scholar
  • 2 Sueki S, Sakurada T, Miyamoto M et al. Change in skin perfusion pressure after the creation of upper limb arteriovenous fistula for maintenance hemodialysis access. Hemodial Int 2014; 18 : 19-S22
    CrossrefGoogle Scholar
  • 3 Schanzer H, Eisenberg D. Management of steal syndrome resulting from dialysis access. Semin Vasc Surg 2004; 17: 45-49
    CrossrefPubMedGoogle Scholar
  • 4 Beathard GA, Spergel LM. Hand ischemia associated with dialysis vascular access: an individualized access flow-based approach to therapy. Semin Dial 2013; 26: 287-314
    CrossrefGoogle Scholar
  • 5 Vaes RH, Tordoir JH, Scheltinga MR. Blood flow dynamics in patients with hemodialysis access-induced hand ischemia. J Vasc Surg 2013; 58: 446-451
    CrossrefGoogle Scholar
  • 6 Scheltinga MR, Bruijninckx CM. Haemodialysis access-induced distal ischaemia (HAIDI) is caused by loco-regional hypotension but not by steal. Eur J Vasc Endovasc Surg 2012; 43: 218-223
    CrossrefGoogle Scholar
  • 7 Vaes RH, Scheltinga MR. Side branch ligation for haemodialysis-access-induced distal ischaemia. Eur J Vasc Endovasc Surg 2012; 44: 452-456
    CrossrefGoogle Scholar
  • 8 Scali ST, Huber TS. Treatment strategies for access-related hand ischemia. Semin Vasc Surg 2011; 24: 128-136
    CrossrefGoogle Scholar
  • 9 Davidson D, Louridas G, Guzman R et al. Steal syndrome complicating upper extremity hemoaccess procedures: incidence and risk factors. Can J Surg 2003; 46: 408-412
    Google Scholar
  • 10 Rocha A, Silva F, Queiros J et al. Predictors of steal syndrome in hemodialysis patients. Hemodial Int 2012; 16: 539-544
    CrossrefGoogle Scholar
  • 11 Gupta N, Yuo TH, Konig G et al. Treatment strategies of arterial steal after arteriovenous access. J Vasc Surg 2011; 54: 162-167
    CrossrefGoogle Scholar
  • 12 Goff CD, Sato DT, Bloch PH et al. Steal syndrome complicating hemodialysis access procedures: Can it be predicted?. Ann Vasc Surg 2000; 14: 138-144
    CrossrefGoogle Scholar
  • 13 Tynan-Cuisinier GS, Berman SS. Strategies for predicting and treating access induced ischemic steal syndrome. Eur J Vasc Endovasc Surg 2006; 32: 309-315
    CrossrefGoogle Scholar
  • 14 Valentine RJ, Bouch CW, Scott DJ et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg 2002; 36: 351-356
    Google Scholar
  • 15 Tordoir JH, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 2004; 27: 1-5
    CrossrefGoogle Scholar
  • 16 Thermann F, Kornhuber M. Ischemic monomelic neuropathy: a rare but important complication after hemodialysis access placement – a review. J Vasc Access 2011; 12: 113-119
    CrossrefGoogle Scholar
  • 17 Mickley V. Steal syndrome – strategies to preserve vascular access and extremity. Nephrol Dial Transplant 2008; 23: 19-24
    PubMedGoogle Scholar
  • 18 Raynaud A, Novelli L, Rovani X et al. Radiocephalic fistula complicated by distal ischemia: treatment by ulnar artery dilatation. Cardiovasc Intervent Radiol 2010; 33: 223-225
    CrossrefGoogle Scholar
  • 19 Samaha A, Salman L, Asif A. Arterial angioplasty to treat hand ischemia in a radial-cephalic fistula. Semin Dial 2009; 22: 561-563
    CrossrefGoogle Scholar
  • 20 Basile C, Lomonte C, Vernaglione L et al. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant 2008; 23: 282-287
    PubMedGoogle Scholar
  • 21 Zanow J, Kruger U, Petzold M et al. Arterioarterial prosthetic loop: a new approach for hemodialysis access. J Vasc Surg 2005; 41: 1007-1012
    CrossrefGoogle Scholar
  • 22 Scheltinga MR, van H F, Bruyninckx CM. Surgical banding for refractory hemodialysis access-induced distal ischemia (HAIDI). J Vasc Access 2009; 10: 43-49
    Google Scholar
  • 23 Zanow J, Petzold K, Petzold M et al. Flow reduction in high-flow arteriovenous access using intraoperative flow monitoring. J Vasc Surg 2006; 44: 1273-1278
    CrossrefGoogle Scholar
  • 24 Miller GA, Goel N, Friedman A et al. The MILLER banding procedure is an effective method for treating dialysis-associated steal syndrome. Kidney Int 2010; 77: 359-366
    CrossrefGoogle Scholar
  • 25 Minion DJ, Moore E, Endean E. Revision using distal inflow: a novel approach to dialysis-associated steal syndrome. Ann Vasc Surg 2005; 19: 625-628
    CrossrefGoogle Scholar
  • 26 Schanzer H, Schwartz M, Harrington E et al. Treatment of ischemia due to „steal“ by arteriovenous fistula with distal artery ligation and revascularization. J Vasc Surg 1988; 7: 770-773
    CrossrefGoogle Scholar
  • 27 Zanow J, Krueger U, Reddemann P et al. Experimental study of hemodynamics in procedures to treat access-related ischemia. J Vasc Surg 2008; 48: 1559-1565
    CrossrefGoogle Scholar
  • 28 Schäfer J. Stealsyndrom nach Dialysezugang. Gefäßchirurgie 2010; 15: 549-564
    CrossrefGoogle Scholar
  • 29 Miller GA, Khariton K, Kardos SV et al. Flow interruption of the distal radial artery: treatment for finger ischemia in a matured radiocephalic AVF. J Vasc Access 2008; 9: 58-63
    Google Scholar
  • 30 Shukla PA, Contractor S, Huang JT et al. Coil embolization as a treatment alternative for dialysis-associated steal syndrome. Vasc Endovascular Surg 2012; 46: 546-549
    CrossrefGoogle Scholar
  • 31 Bourquelot P, Gaudric J, Turmel-Rodrigues L et al. Proximal radial artery ligation (PRAL) for reduction of flow in autogenous radial cephalic accesses for haemodialysis. Eur J Vasc Endovasc Surg 2010; 40: 94-99
    CrossrefGoogle Scholar
  • 32 van H F, Scheltinga M, Luirink M et al. Banding of hemodialysis access to treat hand ischemia or cardiac overload. Semin Dial 2009; 22: 204-208
    CrossrefGoogle Scholar
  • 33 Thermann F, Ukkat J, Wollert U et al. Dialysis shunt-associated steal syndrome (DASS) following brachial accesses: the value of fistula banding under blood flow control. Langenbecks Arch Surg 2007; 392: 731-737
    CrossrefGoogle Scholar
  • 34 Shintaku S, Kawanishi H, Moriishi M et al. Modified MILLER banding procedure for managing high-flow access and dialysis-associated steal syndrome. J Vasc Access 2015; 16: 227-232
    CrossrefGoogle Scholar
  • 35 Anaya-Ayala JE, Pettigrew CD, Ismail N et al. Management of dialysis access-associated „steal“ syndrome with DRIL procedure: challenges and clinical outcomes. J Vasc Access 2012; 13: 299-304
    CrossrefGoogle Scholar
  • 36 Knox RC, Berman SS, Hughes JD et al. Distal revascularization-interval ligation: a durable and effective treatment for ischemic steal syndrome after hemodialysis access. J Vasc Surg 2002; 36: 250-255
    CrossrefGoogle Scholar
  • 37 Aimaq R, Katz SG. Using distal revascularization with interval ligation as the primary treatment of hand ischemia after dialysis access creation. J Vasc Surg 2013; 57: 1073-1078
    CrossrefGoogle Scholar
  • 38 Huber TS, Brown MP, Seeger JM et al. Midterm outcome after the distal revascularization and interval ligation (DRIL) procedure. J Vasc Surg 2008; 48: 926-932
    CrossrefGoogle Scholar
  • 39 Stolic RV, Trajkovic GZ, Miric DJ et al. Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis. World J Nephrol 2013; 2: 26-30
    Google Scholar
  • 40 Scali ST, Chang CK, Raghinaru D et al. Prediction of graft patency and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia. J Vasc Surg 2013; 57: 451-458
    CrossrefGoogle Scholar
  • 41 Zanow J, Kruger U, Scholz H. Proximalization of the arterial inflow: a new technique to treat access-related ischemia. J Vasc Surg 2006; 43: 1216-1221
    CrossrefPubMedGoogle Scholar
  • 42 Thermann F, Wollert U, Ukkat J et al. Proximalization of the arterial inflow (PAI) in patients with dialysis access-induced ischemic syndrome: first report on long-term clinical results. J Vasc Access 2010; 11: 143-149
    Google Scholar
  • 43 Matoussevitch V, Konner K, Gawenda M et al. A modified approach of proximalization of arterial inflow technique for hand ischemia in patients with matured basilic and cephalic veins. Eur J Vasc Endovasc Surg 2014; 48: 472-476
    CrossrefGoogle Scholar
  • 44 Jennings W, Brown R, Blebea J et al. Prevention of vascular access hand ischemia using the axillary artery as inflow. J Vasc Surg 2013; 58: 1305-1309
    CrossrefGoogle Scholar
  • 45 Corfield L, Muller J, Ryan J et al. Distalization of the anastomosis: an effective treatment for dialysis access-associated steal syndrome. Ann Vasc Surg 2012; 26: 572-573
    Google Scholar
  • 46 Callaghan CJ, Mallik M, Sivaprakasam R et al. Treatment of dialysis access-associated steal syndrome with the „revision using distal inflow“ technique. J Vasc Access 2011; 12: 52-56
    CrossrefGoogle Scholar
  • 47 Chemla ES, Morsy M, Anderson L et al. Inflow reduction by distalization of anastomosis treats efficiently high-inflow high-cardiac output vascular access for hemodialysis. Semin Dial 2007; 20: 68-72
    CrossrefGoogle Scholar
  • 48 Vaes RH, van L M, Vaes SM et al. One-year efficacy of the RUDI technique for flow reduction in high-flow autologous brachial artery-based hemodialysis vascular access. J Vasc Access 2015; 16 : S96-S101
    CrossrefGoogle Scholar
  • 49 Leake AE, Winger DG, Leers SA et al. Management and outcomes of dialysis access-associated steal syndrome. J Vasc Surg 2015; 61: 754-760
    CrossrefGoogle Scholar