Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000200007
Jornal Vascular Brasileiro
Original Article

Tratamento cirúrgico da "síndrome do roubo" em acesso vascular para hemodiálise com revascularização distal e ligadura arterial

Surgical treatment of "steal syndrome" at hemodialysis vascular access with revascularization and distal artery ligation

Fábio Linardi; Felipe de Francisco Linardi; José Luis Bevilacqua; José Francisco Moron Morad; José Augusto Costa

Downloads: 0
Views: 34

Resumo

OBJETIVO: O propósito do trabalho é apresentar o resultado do tratamento da "síndrome do roubo", sintomática em acesso vascular para hemodiálise, utilizando a técnica da revascularização distal com ligadura arterial. PACIENTES E MÉTODOS: No período de dezembro de 2003 a novembro de 2004, quatro pacientes que apresentaram síndrome do roubo sintomática em acesso vascular para hemodiálise foram submetidos à revascularização distal com ligadura arterial e acompanhados até dezembro de 2005. Os quatro pacientes apresentavam dor de repouso, e dois casos evoluíram para lesão trófica. RESULTADOS: Todos os casos apresentaram regressão dos sintomas, com cicatrização das lesões tróficas e manutenção do acesso vascular, que continuou sendo utilizado para realização de sessões de hemodiálise. CONCLUSÕES: Concluímos que, atualmente, o tratamento de escolha da síndrome do roubo sintomática é a revascularização distal com ligadura arterial, pois, além de tratar a isquemia do membro, mantém o acesso vascular funcionante.

Palavras-chave

Acesso vascular, síndrome do roubo, hemodiálise, fístula arteriovenosa

Abstract

OBJECTIVE: The authors report results for the surgical treatment of ischemic "steal syndrome" resulting from hemodialysis vascular access with distal revascularization-interval ligation procedure. METHODS: From December 2003 through November 2004, four patients with "steal syndrome" resulting from hemodialysis vascular access were submitted to distal revascularization-interval ligation and followed until December 2005. All four patients had rest pain and two developed ulcerations. RESULTS: All patients presented regression of symptoms, healing of ulcerations, and continued to use the same vascular access for hemodialysis. CONCLUSION: The authors conclude that the distal revascularization-interval ligation procedure is the treatment of choice for ischemic "steal syndrome", since it effectively treats the ischemic symptoms and maintains a functioning vascular access.

Keywords

Vascular access, steal syndrome, hemodialysis, arteriovenous fistula

References

Hakim R, Himmelfarb J. Hemodialysis access failure: a call to action. Kidney Int.. 1998;54:1029-40.

Knox RC, Berman SS, Hughes JD, Gentile AT, Mills JL. Distal revascularization-interval ligation: a durable and effective treatment for ischemic steal syndrome after hemodialysis access. J Vasc Surg.. 2002;36:250-5.

Schanzer H, Schwartz M, Harrington E, Haimov M. Treatment of ischemia due to "steal" by arteriovenous fistula with distal artery ligation and revascularization. J Vasc Surg.. 1988;7:770-3.

Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and characteristics of patients with hand ischemia after a hemodialysis access procedure. J Surg Res.. 1998;74:8-10.

DeCaprio JD, Valentine RJ, Kakish HB, Awad R, Hagino RT, Clagett GP. Steal syndrome complicating hemodialysis access. Cardiovasc Surg.. 1997;5:648-53.

Rivers SP, Scher LA, Veith FJ. Correction of steal syndrome secondary to hemodialysis access fistulas: A simplified quantitative technique. Surgery. 1992;112:593-7.

Barnes RW. Hemodynamics for the vascular surgeon. Arch Surg.. 1980;115:216-23.

Haimov M, Schanzer H, Skladani M. Pathogenesis and management of upper-extremity ischemia following angioaccess surgery. Blood Purif.. 1996;14:350-4.

Kwun KB, Schanzer H, Finkler N, Haimov M, Burrows L. Hemodynamic evaluation of angioaccess procedures for hemodialysis. Vasc Surg.. 1979;13:170-7.

Anderson CB, Etheredge EE, Harter HR, Codd JE, Graff RJ, Newton WT. Blood flow measurements in arteriovenous dialysis fistulas. Surgery. 1977;81:459-61.

Lazarides MK, Staramos DN, Panagopoulos GN, Tzilalis VD, Eleftheriou GJ, Dayantas JN. Indications for surgical treatment of angioaccess-induced arterial "steal". J Am Coll Surg.. 1998;187:422-6.

Berman SS, Gentile AT, Glickman MH. Distal revascularization-interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome. J Vasc Surg.. 1997;26:393-402.

Rosental JJ, Bell DD, Gaspar MR, Movius HJ, Lemire GG. Prevention of high flow problems of arteriovenous grafts: Development of a new tapered graft. Am J Surg.. 1980;140:231-3.

Wixon CL, Hughes JD, Mills JL. Understanding strategies for the treatment of ischemic steal syndrome after hemodialysis access. J Am Coll Surg.. 2000;191:301-10.

Schanzer H, Skladany M, Haimov M. Treatment of angioaccess-induced ischemia by revascularization. J Vasc Surg. 1992;16:861-4.

Katz S, Kohl RD. The treatment of hand ischemia by arterial ligation and upper extremity bypass after angioaccess surgery. J Am Coll Surg.. 1996;183(239).

5dea407a0e88252c022afa9e jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections