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Percutaneous Management of Dialysis Access Steal Syndrome: Interventions and Outcomes from a Single Institution's 20-Year Experience.
Rigsby, Devyn C; Clark, Timothy W I; Vance, Ansar Z; Chittams, Jesse; Cohen, Raphael; Mantell, Mark P; Kobrin, Sidney; Trerotola, Scott O.
Afiliación
  • Rigsby DC; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Clark TWI; Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Vance AZ; Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Chittams J; Biostatistics Consulting Unit, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
  • Cohen R; Department of Medicine, Division of Renal, Electrolyte, and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Mantell MP; Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.
  • Kobrin S; Department of Medicine, Division of Renal, Electrolyte, and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Trerotola SO; Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: STreroto@pennmedicine.upenn.edu.
J Vasc Interv Radiol ; 35(4): 601-610, 2024 Apr.
Article en En | MEDLINE | ID: mdl-38171415
ABSTRACT

PURPOSE:

To determine safety and effectiveness of percutaneous interventions performed by interventional radiologists at a single institution over 2 decades in patients with dialysis access steal syndrome (DASS). MATERIALS AND

METHODS:

A retrospective review of fistulograms from 2001 to 2021 (N = 11,658) was performed. In total, 286 fistulograms in 212 patients with surgically created dialysis accesses met inclusion criterion of fistulography for suspected DASS. Chart review collected data regarding patient demographics, comorbidities, access characteristics, fistulography findings, intervention(s) performed, and outcomes. Procedures with and without DASS intervention were compared. Odds ratios (ORs), adjusted for age, sex, comorbidities, access characteristics, and multiple within-patient events, were calculated using logistic regression to determine associations between steal intervention status and outcome variables (a) major adverse events, (b) access preservation, and (c) follow-up surgery. A percutaneously treatable cause of DASS was present in 128 cases (45%). Treatment of DASS lesions was performed in 118 cases. Fifteen embolizations were also performed in patients without DASS lesions.

RESULTS:

Technical success of DASS interventions, defined by the Society of Interventional Radiology (SIR) reporting standards, was 94%; 54% of interventions resulted in DASS symptom improvement at a median follow-up of 15 days. Patients with steal intervention had 60% lower odds of follow-up surgery (OR, 0.4; P = .007). There was no difference in major adverse events (P = .98) or access preservation (P = .13) between groups.

CONCLUSIONS:

In this retrospective cohort study, approximately half of DASS fistulograms revealed a percutaneously treatable cause of steal. Over half of DASS interventions resulted in symptomatic relief. Percutaneous intervention was associated with lower odds of follow-up surgery without compromising access preservation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades Vasculares / Derivación Arteriovenosa Quirúrgica Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Vasc Interv Radiol Asunto de la revista: ANGIOLOGIA / RADIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades Vasculares / Derivación Arteriovenosa Quirúrgica Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Vasc Interv Radiol Asunto de la revista: ANGIOLOGIA / RADIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos