[Fistula Banding - Success-promoting Approach in Peripheral Steal Syndrome].

Aim: Evaluation of the diagnostic and therapeutic management of peripheral steal syndrome after placement of an autologous arteriovenous (av-) fistula and presentation of treatment results after its surgical correction.
Methods: During a time period from 1994 to 1999, 1 253 av-fistulas for hemodialysis were placed in our surgical department. Twenty-one patients (1.68 %) underwent service operations because of considerable lower perfusion of the hand. In 14 patients the av-fistula was ligated, whereas in 7 patients, a polytetrafluorethylene (PTFE) sleeve was implanted at the venous site for fistula "banding" to diminish blood flow. In addition to the clinical finding, pre-, intra- and postoperative blood flow rates were determined using Duplex ultrasonography.
Results: In patients showing flow rates of < 250 ml (carefully disclosed empiric value) ligation was chosen, whereas in cases with distinctly increased flow rates, banding of the arterialized vein was performed (authors' individually selected borderline flow). The extension of the banding was specified according to the intraoperatively determined flow rates. Recurrent steal syndrome was not observed over the entire postoperative observation period of 1-3 years.
Conclusion: Arterial steal syndrome is a rare complication after placement of an av-fistula. In the majority of cases, surgical therapy is necessary. Pre- and intraoperative analysis of flow rates using Duplex ultrasonography may help to select the appropriate surgical approach and may, thus, determine the success rate of service operation.