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A radiocephalic fistula. Illustration depicting AV fistula during hemodialysis. AV (arteriovenous) fistulas are recognized as the preferred access method. To create a fistula, a vascular surgeon joins an artery and a vein together through anastomosis. Since this bypasses the capillaries, blood flows rapidly through the fistula. One can feel ...
Vascular access steal syndrome is a syndrome caused by ischemia (not enough blood flow) resulting from a vascular access device (such as an arteriovenous fistula or synthetic vascular graft–AV fistula) that was installed to provide access for the inflow and outflow of blood during hemodialysis.
An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. [1] It may be congenital , surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm .
Surgically created AV fistulas work effectively because they: Have high volume flow rates (as blood takes the path of least resistance; it prefers the (low resistance) AV fistula over traversing (high resistance) capillary beds). Use native blood vessels, which, when compared to synthetic grafts, [5] are less likely to develop stenoses and fail.
Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of filtering the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinine and urea and free water from the blood when the kidneys are in a state of kidney failure .
Revision Using Distal Inflow (RUDI) is a surgical treatment for Dialysis-associated Steal Syndrome. RUDI was first proposed by David J. Minion and colleagues in 2005. In the procedure, the fistula is ligated at a location slightly proximal to the anastomosis. A bypass to the venous outflow is then created from a distal arterial source.
MILLER (Minimally Invasive Limited Ligation Endoluminal-assisted Revision) banding is a minimally invasive technique for banding dialysis accesses in cases of Dialysis-associated Steal Syndrome. MILLER banding was first proposed in 2006 by Goel N., Miller G.A., and colleagues. [1] [2]
PICC lines may also result in venous thrombosis and stenosis, and should therefore be used cautiously in patients with chronic kidney disease in case an arteriovenous fistula might one day need to be created for hemodialysis. [40] [41] However, PICC lines are desirable for several reasons. They can provide venous access for up to one year.