464-169 | Treatment of Ischemic Steal Syndrome in a Patient with Aberrant Arterial Anatomy Following Dialysis Access Surgery-JVU 464-169

JVU 464-169

Pdf Summary

This case report discusses a 44-year-old female patient with end-stage renal disease who developed symptomatic ischemic steal syndrome (ISS) following a radio-cephalic fistula surgery. Ultrasound evaluation revealed abnormal blood flow in the radial artery and an aberrant connection between the radial and ulnar arteries. These findings guided the development of a surgical plan to ligate the radial artery, which resulted in resolution of the ISS symptoms. <br /><br />ISS is a complex complication that occurs in a small number of patients who have undergone a dialysis access procedure. It is characterized by inadequate blood flow to the hand, resulting in pain and tissue loss. The factors that cause ISS are complex, but ultrasound examination can help in understanding the anatomy and hemodynamics of the arteriovenous fistula (AVF). <br /><br />Various surgical procedures have been developed to treat ISS by altering the hemodynamics of the dialysis circuit. In this case, the surgical plan involved ligation of the radial artery distal to the AVF anastomosis but proximal to the aberrant connection between the radial and ulnar arteries. Postoperative ultrasound examination confirmed a patent AVF with adequate flow and resolved symptoms.<br /><br />The authors emphasize the importance of ultrasound evaluation in assessing the hemodynamic patterns associated with AVFs and aiding in preoperative planning for correction of ISS in patients with aberrant anatomy. This case report adds to the existing knowledge on the management of symptomatic ISS in patients undergoing dialysis access surgery.

Keywords

symptomatic ischemic steal syndrome

radio-cephalic fistula surgery

ultrasound evaluation

abnormal blood flow

radial artery

aberrant connection

surgical plan

ligate the radial artery

dialysis access procedure

preoperative planning