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Home > Vascular Annual Meeting > RR7. Treatment Strategies of Arterial Steal...

RR7. Treatment Strategies of Arterial Steal After Arterio-Venous (AV) Access

Navyash Gupta, Theodore H. Yuo, Gerhardt Konig, Ellen D. Dillavou, Steven A. Leers, Rabih A. Chaer, Jae S. Cho, Michel S. Makaroun
University of Pittsburgh, Pittsburgh, PA

OBJECTIVES: Ischemic steal (IS) associated with an AV access is rare, but can result in severe complications. Multiple techniques have been described to treat IS with varying degrees of success. This study compares these options.

METHODS: Patients with IS from June 2003 to August 2008 were reviewed. Demographics, type of AV access, management technique and success of intervention were recorded. Success was defined as resolution of IS symptoms while preserving access function. Further, 100 consecutive AV access procedures were reviewed for current practice patterns. We analyzed data using z- and chi-squared tests. The study was approved by our IRB.

RESULTS: A total of 114 patients with IS had a mean age of 65 years (range 20-90) and were predominantly female (66%), diabetic (61%), and had proximal brachio-cephalic or brachio-basilic fistulas (69%). Women were noted to have a brachial artery origin more frequently than men (OR 3.1, p=0.009) in current practice. Forty-four mild cases were observed uneventfully. Results of 87 interventions on 70 patients are in Table 1. Of these, 31 early procedures (<30 days from index fistula) were mostly ligation (42%) or banding (45%) while Distal Revascularization, Interval Ligation (DRIL) was the most frequent choice for late interventions (38%). DRIL had a better success rate than banding (p≤0.05). Of the 11 patients requiring repeat intervention, the majority had failed banding procedures (73%). In our current practice, 18% of patients had an AV fistula with the proximal radial artery (PRA) as the inflow source, while this type of fistula accounted for only 2% of all IS patients. Ligation resolved symptoms in all patients, but the AV access was lost.

CONCLUSIONS: Among various options to treat IS, banding has a low success rate and high likelihood for re-intervention, while DRIL is particularly effective, though not uniformly. Women have more IS probably because they frequently have more proximal access. Use of the PRA as the inflow source may decrease the incidence of IS.

AUTHOR DISCLOSURES: N. Gupta, None; T.H. Yuo, None; G. Konig, None; E.D. Dillavou, None; S.A. Leers, None; R.A. Chaer, None; J.S. Cho, None; M.S. Makaroun, None.

Table 1.