Steal Syndrome Surgical Treatment,

A planned for distal revascularizationinterval ligation [DRIL] procedure

& The Difficulties in a rural General mind set area support
Arga P, Niko AH, Heru K
Department of Surgery,Division of Thoracic & Cardiovascular Surgery
Faculty of Medicine Airlangga University Dr. Soetomo Teaching Hospital
Surabaya Indonesia
Objective: The ischemic ``steal'' syndrome complicates angioaccesss in a growing number of
hemodialysed patients. Until now, operative attempts (fistula ligation or banding) to treat this
problem have met with only limited success. This case report aimed to review the difficulties
of the planned to DRIL (distal revascularization interval ligation) procedure in treating the
``steal'' syndrome, in rural area support. Methods: A case review was happened of a patient
who planned underwent the DRIL procedure in elective, but have had the cancellations so
that the patient should have a different plan to underwent the bloody surgery. The patient was
first admitted in a urgent state to do the surgery, due to inadequate medical mind set he was
cancelled 3 times to do the elective surgery. The arteriovenous access, which led to the
``steal'' syndrome, was proximally located in the cubital. ``Steal'' symptoms included hand
pain, paraesthesia, neurologic deficits and gangrenous ulcers. Discussions: In actual selected
patients electively the DRIL procedure is a safe and effective way to treat the ``steal''
syndrome. But the essential support by the surgical partner (Anesthetist) who wasnt thought
in general mind set were very important to treat the Steal Syndrome in a Chronic Kidney
Disease patients.