Pledgeted plication: A novel technique to treat dialysis access-related steal syndrome

Thomas Vierhout; Hector Saucedo-Crespo; Christopher Auvenshine; Sujit Vijay Sakpal

doi:10.1177/2050313X221083513

Pledgeted plication: A novel technique to treat dialysis access-related steal syndrome

SAGE Open Med Case Rep. 2022 Mar 15:10:2050313X221083513. doi: 10.1177/2050313X221083513. eCollection 2022.

Authors

Thomas Vierhout¹, Hector Saucedo-Crespo^{2

3}, Christopher Auvenshine^{2

3}, Sujit Vijay Sakpal^{2

3

4}

Affiliations

¹ Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
² Avera McKennan Hospital & University Health Center, Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA.
³ Department of Surgery, University of South Dakota, Sioux Falls, SD, USA.
⁴ Department of Internal Medicine, University of South Dakota, Sioux Falls, SD, USA.

Abstract

Steal syndrome is a potential complication of surgically created arteriovenous fistulas that can result in sensory and/or motor deficits, or tissue loss in the affected limb. Several surgical techniques have been developed to treat steal syndrome, but all have potential drawbacks. We detail a novel, modified plication technique which involves sequential, longitudinal application of pledgets along the venous outflow to gradually narrow it, and consequently decrease flow. Its potential benefits include protection of the vein from bare suture, less turbulent flow, and thus lower risk of thrombosis. Implementation of this technique in two patients resulted in symptomatic relief and continuation of uninterrupted hemodialysis at 9- and 12-month follow-up, respectively.

Keywords: Arteriovenous fistula; hemodialysis; plication technique; steal syndrome.

Publication types

Case Reports