• Author
    Lara Sak
  • Discovery PI

    Christian de Virgilio, MD

  • Project Co-Author

    Joanna Curry, Christian de Virgilio, MD, Mark Archie, MD, Nikhil Kansal, MD, Nina Bowens, MD, Meena Archie, MD

  • Abstract Title

    Comparative Outcomes of Plication and DRIL/PAI in the Management of Dialysis Access-Associated Steal Syndrome

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Background: The optimal surgical approach to dialysis access-associated steal syndrome (DASS) is debatable. Distal revascularization with interval ligation (DRIL) and proximalization of arterial inflow (PAI) are thought to be more definitive, but more complex, whereas plication is simpler, but may carry higher risks of access thrombosis or failure of symptom resolution.

    Objectives: We aim to compare outcomes between plication and DRIL/PAI. 

    Methods: We retrospectively reviewed 1,430 consecutive patients who underwent arteriovenous fistula (AVF) or graft (AVG) creation (2014-2019) at five safety-net hospitals. Patients who underwent plication or DRIL/PAI for DASS were included in the analysis, and those who underwent more minor interventions such as ligation and superficialization were excluded. Outcomes included symptom improvement, recurrent steal, reoperation, 1-year access patency, and 30-day and 1-year mortality. 

    Results: Overall, 54 (3.8%) developed DASS, of which 38 (70%) underwent surgery. Of these, plication (n=11) and DRIL/PAI (n=10) were compared; the remainder underwent other minor interventions (n=17). Mean age was 60 ± 8.5 years (33% male). Demographics were similar except for hypertension (55% plication, 100% DRIL/PAI, p=0.04). Access type differed between groups: 91% of plication had brachiocephalic AVFs compared to 40% of DRIL/PAI (p=0.02). DASS grade and anesthetic modality were similar between groups. Complete symptom resolution rate, reoperation rate, recurrent steal rate, 30-day mortality, 1-year mortality, and 1-year patency did not differ significantly between groups.

    Conclusion: Plication demonstrated comparable rates of symptom resolution, reoperation, and patency to DRIL/PAI, but with no mortality. These findings support plication as a viable surgical option for DASS, particularly for brachiocephalic AVFs, though given our small sample size, further studies may be indicated.

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