Module 8: Hand Ischemia: Dialysis Access Steal Syndrome
Dialysis Access Steal Syndrome (DASS), is a potentially devastating complication that occurs in 5-10% of cases when the distal brachial artery is used as inflow, which is g about 10 times that of wrist arteriovenous fistulas (AVFs) using the distal radial artery. Depending on the type and location of arteriovenous (AV) access the risk of severe access-related steal syndrome stage III or IV varies. Following the creation of a femoral access, an even higher incidence of steal syndrome has been reported. Due to the rise in the median ages of incidence and prevalence of hemodialysis patients and due to the growing percentages of diabetics among them, access-related ischemia has become a growing problem. Unrecognized and untreated steal may carry severe morbidity including tissue or limb loss.
There are three distinct etiologies that may occur alone or in concert:
- Blood flow restriction to the hand from arterial occlusive disease proximal or distal to the AV access anastomosis
- Excess blood flow through the AV access (true steal)
- Lack of vascular (arterial) adaptation or collateral flow reserve (i.e. atherosclerosis) to the increased flow demand from the AV access
- List and describe three distinct etiologies of the steal syndrome
- Classify steal by graded severity
- Verbalize treatment options of the steal syndrome
- Identify common risk factors for steal
- List strategies to prevent steal
Method of Participation
To obtain credit, a score of 70% or better on the post-test is required. Please proceed with the activity until you have reviewed module materials, successfully answered all post-test questions, completed the evaluation, and have received a digital copy of your CME certificate. You must participate in the entire activity to receive credit. If you have questions about this CME activity, please contact Complete Conference Management at cme@CCMCME.com.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Complete Conference Management and Online CME, Inc.
Complete Conference Management is accredited by the ACCME to provide continuing medical education for physicians.
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.
Complete Conference Management designates this enduring activity for a maximum of 3.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Ingemar Davidson, MD, PhD, FACS
Dr. Davidson has no relevant financial relationships reported.
Gerald Beathard, MD, PhD
Dr. Beathard has no relevant financial relationships reported.
Bart Dolmatch, MD, FSIR Dr. Dolmatch is a consultant and advisor to Bard, Humacyte, Bluegrass Vascular Tech, Merit Medical and Histosonics.
Nicholas Inston, MD, PhD
Dr. Inston has been an investigator for TVA and Humacyte and an educational consultant for Merit Medical, Gore and SynerMed.
Behram Kahn, MD
Dr. Kahn has no relevant financial relationships reported study.
John Ross, MD Dr. Ross is a consultant for Bard Peripheral Vascular, WL Gore and Associates, LeMaitre Vascular Inc. and Boston Scientific.
John Swinnen, MD
Dr. Swinnen has no relevant financial relationships reported study
Magdalena Biss-Mierzwińska, MD
Dr. Magdalena Biss-Mierzwińska has no relevant financial relationships reported.
Pierre Bourquelot, MD
Dr. Bourquelot has no relevant financial relationships reported.
Teresa Chuva, MD
Dr. Teresa Chuva has no relevant financial relationships reported.
Maurizio Gallieni, MD
Dr. Gallieni has no relevant financial relationships reported.
Ulf Hedin, MD
Dr. Hedin has no relevant financial relationships reported.
Jackie Pei Ho, MD
Dr Ho has no relevant financial relationships reported.
Jose Ibeas, MD, PhD
Dr. Ibeas has no relevant financial relationships reported.
Aurang Zaib Khawaja MD
Dr Khawaja has no relevant financial relationships reported
Hailei Li, MD, PhD
Dr. Li has no relevant financial relationships reported.
NC Liew, MD
Dr. Liew has no relevant financial relationships reported
Alexandro Mallios, MD
Dr. Mallios is a consultant and advisor to Avenu Medical
Linda Nuth, MD
Dr. Nuth has no relevant financial relationships reported
Kittipan Perkasem, MD
Dr. Perkasem has no relevant financial relationships reported
Ramon Roca Tey, MD, PhD Dr. Roca Tey has no relevant financial relationships reported.
Tobias Steinke, MD
Dr. Steinke is a consultant and advisor to Angiomed Karlsruhe GER, CR Bard Karlsruhe GER, TVA Medical Austin Texas USA.
Martina Tedesco, MS Dr. Tedesco has no relevant financial relationships reported.
Tracey Fernandez, CMP
Ms. Fernandez has no relevant financial relationships reported.
Barbara O’Brien, MSN, BSN, RN Ms. O’Brien has no relevant financial relationships reported.
This activity is supported by unrestricted educational grants from the following companies: Arrow International, Inc./Teleflex, Lutonix Technology Center/Bard, Boston Scientific Corporation, Le Maitre Vascular, Inc., Medtronic and W.L. Gore
CME Credit hours Earned: 3.0 Hour(s)
Fee: $0.00 - Free
Disclosure Policy Statement
In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support, educational programs sponsored by Complete Conference Management must demonstrate balance, independence, objectivity and scientific rigor. All faculty, authors, editors and planning committee members participating in a CCM-sponsored activity are required to disclose any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services that are discussed in an educational activity.
Disclosure of Unlabeled Use and Investigational Product
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Complete Conference Management makes every effort to develop CME activities that are scientifically based. This activity is designed for educational purposes. Participants have a responsibility to utilize this information to enhance their professional development to improve patient outcomes. Conclusions drawn by the participants should be derived from careful consideration of all available scientific information. The participant should use his/her clinical judgment, knowledge, experience and diagnostic decision-making before applying any information, whether provided here or by others, for any professional use.
Required Hardware / Software
A computer with an internet connection. Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser. Other additional software may be required such as PowerPoint or Adobe Acrobat Reader.
|Access Date||Quiz Result||Score||Actions|