The efficacy of the secondary Extension Technique in the management of arterio-venous fistula-associated steal syndrome.

Abstract

Dialysis-associated steal syndrome remains a difficult clinical scenario for vascular access surgeons. The ideal treatment would improve blood flow to the hand without compromising the fistula; however, most treatment options rarely allow for both. The study describes an innovative technique used in clinical practice over a 17-year period for the treatment of dialysis-associated steal syndrome. The procedure and long-term results are discussed. 27 patients with dialysis-associated steal syndrome were recruited over 17 years at two large UK University Teaching Hospitals and treated with the extension technique. All patients included were assessed for resolution of their symptoms, patency of the fistula and adequacy of needling. 27 patients were admitted with dialysis-associated steal syndrome and underwent surgery using the extension technique. Complete symptom resolution was seen in 26 of the 27 patients (96%), with improvements in pain, sensori-motor disturbance and temperature. All 26 patients had a patent fistula at 6-months' follow-up. At 12 months, 3 of 27 (11.1%) developed fistula thrombosis which could not be salvaged and 2 of 27 (7.4%) developed thrombosis successfully salvaged by fistulaplasty. Our study shows that the Extension Technique is an effective treatment method for dialysis-associated steal syndrome and results have demonstrated a high level of fistula patency and a low rate of complications. It has several advantages when compared with other established treatment methods and has the versatility to be used as a method for dialysis-associated steal syndrome prevention in high-risk groups as well as treatment.