Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000300014
Jornal Vascular Brasileiro
Case Report

Tratamento da síndrome do roubo devido a fístula arteriovenosa para hemodiálise em membro inferior por meio da técnica de ligadura arterial e revascularização distal (técnica de DRIL)

Distal revascularization and interval ligation for the treatment of steal syndrome secondary to hemodialysis arteriovenous fistula in the lower limb

Rafael Demarchi Malgor; Ricardo de Alvarenga Yoshida; Marcone Lima Sobreira; Mariângela Giannini; Winston Bonetti Yoshida; Hamilton Almeida Rollo

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Resumo

RESUMO A fístula arteriovenosa com bom fluxo sangüíneo é de fundamental importância para os pacientes portadores de insuficiência renal crônica em tratamento hemodialítico. Uma das complicações da fístula arteriovenosa é a síndrome do roubo, mas esta é de ocorrência incomum, e o seu tratamento está diretamente indicado quando há sintomas manifestos. Vários métodos foram propostos para sua correção nos membros superiores, sendo considerada a revascularização distal com ligadura arterial o procedimento de escolha. Neste relato de caso inédito, descreve-se o tratamento da síndrome do roubo de uma fístula arteriovenosa realizada em membro inferior, tratada com sucesso por meio da mesma técnica indicada para os membros superiores.

Palavras-chave

Fístula arteriovenosa, hemodiálise, síndrome do roubo, terapêutica

Abstract

Arteriovenous fistula with adequate blood flow is extremely important for patients with chronic renal insufficiency undergoing hemodialysis. Steal syndrome is a complication of arteriovenous fistula, but it is rare and its treatment is directly indicated when there are associated symptoms. Although many treatments have been proposed for its repair in the upper limbs, distal revascularization and interval ligation is currently the treatment of choice. This original case report describes the treatment of steal syndrome secondary to arteriovenous fistula in the lower limb, which was successfully treated using the same procedure described for the upper limbs.

Keywords

Arteriovenous fistula, hemodialysis, steal syndrome, therapeutic approach

References

Romão Jr. JE, Pinto SWL, Canziani ME, Praxedes JN, Santello JL, Moreira JCM. Censo SBN 2002: informações epidemiológicas das unidades de diálise do Brasil. J Bras Nefrol.. 2003;25:187-98.

III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis.. 2001;37(1^s1):S137-81.

Clinical practice guidelines for vascular access. Am J Kidney Dis.. 2006;48(^s1):S248-73.

Schanzer H, Skladany M. Acesso vascular para hemodiálise. Cirurgia vascular: princípios e técnicas. 1999;II:1030-42.

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.

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.

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

Storey BG, George CR, Stewart JH, Tiller DJ, May J, Sheil AG. Embolic and ischemic complications after anastomosis of radial artery to cephalic vein. Surgery. 1969;66:325-7.

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.

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.

Rutherford RB. The value of noninvasive testing before and after hemodialysis access in the prevention and management of complications. Semin Vasc Surg.. 1997;10:157-61.

Katz S, Kohl RD. The treatment of hand ischemia by arterial ligation and upper extremity bypass after angioaccess surgery. J Am Coll Surg.. 1996;183:239-42.

Mwipatayi BP, Bowles T, Balakrishnan S, Callaghan J, Haluszkiewicz E, Sieunarine K. Ischemic steal syndrome: a case series and review of current management. Curr Surg.. 2006;63(2):130-5.

Ehsan O, Bhattacharya D, Darwish A, Al-khaffaf H. 'Extension technique': a modified technique for brachio-cephalic fistula to prevent dialysis access-associated steal syndrome. Eur J Vasc Endovasc Surg.. 2005;29:324-7.

Goff CD, Sato DT, Bloch PH. Steal syndrome complicating hemodialysis access procedure: can it be predicted?. Ann Vasc Surg.. 2000;14:138-44.

Aschwanden M, Hess P, Labs KH, Dickenmann M, Jaeger KA. Dialysis access-associated steal syndrome: the intraoperative use of duplex ultrasound scan. J Vasc Surg.. 2003;37:211-3.

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.

Linardi F, Linardi FF, Bevilacqua JL, Morad JFM, Costa JA. Tratamento cirúrgico da "síndrome do roubo" em acesso vascular para hemodiálise com revascularização distal e ligadura arterial. J Vasc Bras.. 2006;5:117-22.

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

Asciutto G, Geier B, Mumme A. Distal revascularization-interval ligation for the treatment of angioaccess-induced ischemia: Case report. Minerva Urol Nefrol.. 2006;58:91-5.

Tashjian DB, Lipkowitz GS, Madden RL. Safety and efficacy of femoral-based hemodialysis access grafts. J Vasc Surg.. 2002;35:691-3.

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