Ann Surg Treat Res.  2015 Jun;88(6):349-352. 10.4174/astr.2015.88.6.349.

Alternative prosthetic vascular access creation using subscapular artery as inflow to prevent dialysis access related steal syndrome

• Song D
• Yun S

• KMID: 1800650
• DOI: http://doi.org/10.4174/astr.2015.88.6.349

Abstract

In patients highly suspected of developing steal syndrome, the subscapular artery may be a good supplier for functional prosthetic arteriovenous access, as well as a good solution for the prevention of steal syndrome. A 51-year-old woman was preparing to have a loop shaped polytetrafluoroethylene (PTFE) graft placed at the left upper extremity. The diameter of subscapular the artery was 3 mm. Arterial calcification was not evident. The diameter of the basilic vein was 6 mm. A 50-cm long 4-7 mm tapered PTFE graft was placed in a loop shape between both skin incisions. The patient was uneventfully discharged at postoperative day 4 without any remaining steal syndrome. The PTFE graft was well-functioning during the follow-up period. The patient did not experience symptoms of steal syndrome any longer.

Keyword

Dialysis; Ischemia; Polytetrafluoroethylene

MeSH Terms

Arteries*
Dialysis*
Female
Follow-Up Studies
Humans
Ischemia
Middle Aged
Ocimum basilicum
Polytetrafluoroethylene
Skin
Transplants
Upper Extremity
Veins
Polytetrafluoroethylene

Figure

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  Fig. 1 Preoperative arteriogram revealed arteriopathy of upper extremity. There were only interosseous arteries without radial or ulna arteries at bilateral distal upper extremities.

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  Fig. 2 (A) Subscapular artery was identified and dissected from adjacent structures with good field of vision at axillary approach (black arrow). (B) Loop shaped polytetrafluoroethylene graft was placed subcutaneously between two skin incisions. (C) At 8 months postoperatively, percutaneous angioplasty was done for stenosis of graft-venous anastomosis.

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