SS06. Efficacy of Surgical Correction of Dialysis Access Steal Syndrome

Abstract

Surgical options to treat vascular access-related steal syndrome include distal revascularization-interval ligation (DRIL), proximalization of arterial inflow (PAI), access banding, and access ligation. The efficacy of these individual modalities in symptom resolution has not been previously reported. The aim of this study was to compare efficacy of different surgical modalities for treatment of steal associated with arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). Retrospective analysis was performed on adults diagnosed with steal syndrome after hemodialysis access creation who underwent revision of their dialysis access by a singular vascular specialty group within one integrated health care system. Patients <18 years, those with lower extremity accesses, and those with HeRO grafts (Merit Medical, South Jordan, Utah) were excluded. Data were obtained from the electronic medical record system and analyzed using SPSS software (IBM Corp, Armonk, NY). Patients with preintervention duplex ultrasound-confirmed steal were identified and further evaluated by access type (AVG or AVF). The primary end point was clinical symptom resolution. There were 257 patients who underwent surgical interventions for steal syndrome. Of these, 143 patients had a preoperative duplex ultrasound examination suggestive of steal syndrome, with 98 associated with AVF (68.5%) and 45 associated with AVG (31.5%). Our population included predominantly women (65.7%) and African Americans (53.8%), with a mean age of 63.2 years (23-90 years). Symptom resolution for the two groups is reported in the Fig. In the AVF group, there was a statistically significant difference for complete symptom resolution between DRIL, PAI, banding, and access ligation at 64.6%, 80%, 26.3%, and 100%, respectively (χ2 test, P = .001). For AVGs, there was no statistically significant difference in symptom resolution between different surgical modalities (χ2 test; P = .555). In patients with AVF-associated steal, efficacy of DRIL and PAI in symptom resolution was superior to banding with statistical significance. Whereas access ligation had a higher percentage of symptom resolution in this subset, it should be reserved for cases of severe disease or when other viable options are absent. For AVG, clinical judgment and symptoms should be used in guiding surgical treatment preferences for symptom resolution.