Vascular access steal syndrome

Vascular Access Steal Syndrome

Vascular access steal syndrome (VASS) is a condition that occurs when blood flow is diverted from the distal extremity following the creation of a vascular access, such as an arteriovenous fistula or graft, for hemodialysis. This diversion of blood can lead to ischemia in the affected limb, causing symptoms ranging from mild discomfort to severe pain and tissue damage.

Pathophysiology

Vascular access steal syndrome arises when the vascular access shunts blood away from the distal circulation of the limb. This can occur when the fistula or graft has a high flow rate, reducing the perfusion pressure in the distal arteries. The condition is more common in patients with pre-existing peripheral vascular disease or diabetes, as these conditions can compromise the collateral circulation that might otherwise compensate for the reduced blood flow.

Symptoms

The symptoms of vascular access steal syndrome can vary in severity and may include:

• Coldness or pallor of the affected limb
• Pain or discomfort, particularly during exercise or at rest
• Numbness or tingling sensations
• Weakness or muscle cramps
• In severe cases, tissue necrosis or ulceration

Diagnosis

Diagnosis of vascular access steal syndrome typically involves a combination of clinical evaluation and diagnostic tests. Physical examination may reveal signs of ischemia, such as diminished pulses or skin changes. Doppler ultrasound or angiography can be used to assess blood flow and confirm the diagnosis.

Treatment

Treatment options for vascular access steal syndrome depend on the severity of the condition. Mild cases may be managed conservatively with observation and symptomatic treatment. More severe cases may require surgical intervention, such as banding of the fistula, revision of the access, or creation of a new access site. In some cases, distal revascularization procedures may be necessary to restore adequate blood flow to the affected limb.

Prevention

Preventive measures for vascular access steal syndrome include careful planning of the vascular access site, taking into account the patient's vascular anatomy and risk factors. Preoperative assessment with imaging studies can help identify patients at risk and guide the choice of access site and technique.

Related pages

• Arteriovenous fistula
• Hemodialysis
• Peripheral vascular disease

References

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