Treatment of dialysis access-associated steal syndrome with the "revision using distal inflow" technique.

PurposeDialysis access-associated steal syndrome (DASS) is a common, serious complication of antecubital fossa (ACF) arteriovenous fistulas (AVFs). We describe our experience of the “revision using distal inflow” (RUDI) technique for the treatment of DASS and review the literature.MethodsPatients underwent fistula ligation at the anastomosis with re-establishment of inflow via the proximal radial or ulnar arteries using a venous interposition graft or venous collateral. A retrospective analysis of outcomes of all patients undergoing this procedure at our center was carried out.ResultsSeven patients with autogenous ACF AVFs underwent the RUDI procedure, four under local anesthesia. Interposition vein grafts were used in five patients, and inflow was achieved through the proximal radial artery in four cases. The median post-operative rise in digital systolic blood pressure was 65.5 mmHg. Follow-up at 7–36 months found that three fistulas had failed (one at 8 months, two within days), two patients had died w...