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The diagnostic and prognostic value of laser doppler measurements in arterial steal syndrome development after arteriovenous access in patients, under hemodialysis, with real desease

By Κωνσταντίνος Ξηρομερίτης

Abstract

The development of arterial steal syndrome after AV access surgery in patients undergoing chronic hemodialysis is a hazardous event that may put access patency or even limb viability in jeopardy. We examined the predictive value of Laser Doppler in occurrence of the syndrome. Material-method : For the time between 10.01.2005 and 20.11.2006 81 patients (ages 38-90 years) with end-stage renal disease undergoing a primary upper extremity AV access for hemodialysis were prospectively evaluated by Laser Doppler measurements. The mean value of the capillary blood flow of their ipsilateral hand first was obtained preoperatively and on the day of surgery, just after the operation, at 35 and 440C.Two to three months after the A-V access (the vein has taken its final size) these patients undergo another clinical examination and a new measurement of the blood flow in the tissue in order to compare the new values with the past ones.For these patients that after all this procedure we finally have the suspicion of the arterial steal syndrome we submit them to undergo a colour Doppler ultrasound in order to confirm the presence of the steal syndrome. Results : From the total of these 81 patients 20 were diabetics, 32 had symptomatic peripheral arterial disease and 4 of them suffered from Buerger disease. The AV accesses created included the following: autogenous brachial-cephalic (13 = 16 %), autogenous radial-cephalic (32 = 39,5 %), prosthetic brachial-antecubital forearm loop (20 = 24,7 %), and prosthetic brachial-axillary ( 16= 19,8 %). Thirteen(13) patients (16%) developed a symptomatic steal syndrome. Two of them required surgical repair. Mean values are shown in the following table : measurements 0C mean SD Preoperative values at 35 87,117 46,78579 44 204,1034 67,94751 Postoperative Values at 35 45,6223 19,85864 44 112,896 53,28055 difference [Preoperative – postoperative value] 35 41,495 36,00649 44 91,2074 59,62931 166 Logistic regression analysis demonstrated that increasing values of the difference between preoperative and postoperative values either at 350C or 440C, correspond to increasing odds of the arterial steal occurrence (p = 0.018 and p=0.046 respectively) Conclusion : Utilizing laser Doppler measurements, we can reasonably predict the development of a symptomatic steal syndrome.

Topics: Laser doppler, Διαγνωστική και προγνωστική αξία, Νεφροπαθείς ασθενείς, Σύνδρομο αρτηριακής υποκλοπής αιμοκαθαιρόμενων, Μέση τιμή μικροαγγειακής αιματικής ροής, Τϋποι αγγειακών προσπελάσεων, Αγγειοδιαστολή, Τυπική προεγχειρητική και μετεγχειρητική, Σακχαρώδης διαβήτης, Predichive value of laser doppler measurements, Parents under hemodialysis, Arterial steal syndrome in, Blood flow, Meart values of microvascular, Autogenous and prosthetic vascular access, Diabetes
Publisher: National and Kapodistrian University of Athens
Year: 2008
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