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Vascular Steal in Hemodialysis: Still Unpredictable

J. Jeffrey Alexander, M.D.

Joel P. Yuhas, B.S.

MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio

Vascular steal remains a significant cause of morbidity after placement of access for hemodialysis and has been reported to occur at an incidence of 2-8%. The purpose of this study was to identify which factors may predict the development of steal. A retrospective review of new-access placement over a three-year period revealed 275 procedures on 129 patients. There were 225 (82%) prosthetic conduits and 50 (18%) native fistulas placed. Thrombectomies and revisions were excluded. There were 23 cases (8.4% incidence by access) of steal in 19 patients (15% incidence by patient). The consequences of steal included development of a Volkmann's contracture in 4 patients despite ligation of the access in 3, gangrene with loss of digits in 2 patients, decreased motor function in 3 patients, and refusal of dialysis and subsequent death in 1 patient. Five patients had mild symptoms that resolved spontaneously. Thirty-nine percent (n = 9) of the steal cases occurred in secondand third-access placements. By univariate analysis the factors that predicted steal were increased age (63.1 ± 14 years versus 52.0 ± 16.2 years; P = 0.002), female sex (14.4% in women compared with 1.6% in men; P = 0.003). Diabetes mellitus was also more prevalent (12.3% compared with 3.4% in non-diabetics; P = 0.08) but did not reach statistical significance. There was no relationship to type of access performed, conduit used, and location. When combinations of these factors are fitted to a multivariate logistic regression, the best combination results in only 19% of the variation in outcome (steal) being explained (r = 0.43; P = 0.001). Vascular steal remains a common, serious cause of morbidity in dialysis access placement. Although it is more common in elderly diabetic women, accurate prediction based on clinical variables alone is not possible.

Vascular and Endovascular Surgery, Vol. 30, No. 4, 289-292 (1996)
DOI: 10.1177/153857449603000404


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