{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:06:56Z","timestamp":1760058416403,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T00:00:00Z","timestamp":1743897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Vascular steal refers to the diversion of blood flow between collateral vessels that share a common inflow restricted by arterial stenosis. Blood is diverted from the high-pressure to the low-pressure, low-resistance system. Vascular steal is associated with anatomical bypass or vasodilation in the collateral network and is called \u201cthe arterial steal\u201d. However, we have demonstrated that in the presence of an outflow gradient (e.g., intra-extracranial), blood is shunted to a lower pressure system, a phenomenon we term \u201cvenous steal\u201d. Using Thevenin\u2019s equivalent, we generalized the concept of venous steal to apply it to any region of the vascular system with increased outflow pressure. Both arterial steal, caused by increased collateral network conductivity, and venous steal, resulting from lower collateral outflow pressure, reduce compartment perfusion. This occurs indirectly by increasing flow and the pressure gradient across the arterial stenosis, lowering the segmental compartment perfusion pressure\u2014the difference between post-stenotic (inflow) and compartmental (outflow) pressures. Venous steal diverts blood flow from compartments with elevated pressure, such as intracranial, subendocardial, the ischemic core, and regions of focal edema due to inflammation, trauma, or external compression. In shock and low-flow states, it contributes to regional blood flow maldistribution. Treatment of venous steal addresses inflow stenosis, increased compartmental pressure and systemic loading conditions (arterial and venous pressure) to reverse venous steal malperfusion in the ischemic regions.<\/jats:p>","DOI":"10.3390\/medicina61040672","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T08:46:20Z","timestamp":1744274780000},"page":"672","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Concept of Venous Steal: The Impact of Vascular Stenosis and Outflow Pressure Gradient on Blood Flow Diversion"],"prefix":"10.3390","volume":"61","author":[{"given":"Mindaugas","family":"Pranevi\u010dius","sequence":"first","affiliation":[{"name":"Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dalius","family":"Makackas","sequence":"additional","affiliation":[{"name":"Department of Applied Informatics, Faculty of Informatics, Kaunas University of Technology, 50254 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4048-3065","authenticated-orcid":false,"given":"Andrius","family":"Macas","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K\u0119stutis","family":"Petrikonis","sequence":"additional","affiliation":[{"name":"Department of Neurology, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gintar\u0117","family":"\u0160akalyt\u0117","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osvaldas","family":"Pranevi\u010dius","sequence":"additional","affiliation":[{"name":"Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rimantas","family":"Benetis","sequence":"additional","affiliation":[{"name":"Department of Heart, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1113\/jphysiol.1896.sp000596","article-title":"On the Absorption of Fluids from the Connective Tissue Spaces","volume":"19","author":"Starling","year":"1896","journal-title":"J. Physiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1152\/jappl.1982.53.6.1496","article-title":"A Starling resistor regulates cerebral venous outflow in dogs","volume":"53","author":"Luce","year":"1982","journal-title":"J. Appl. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1152\/jappl.1995.79.1.214","article-title":"Pressure-flow relationships in in vitro model of compartment syndrome","volume":"79","author":"Shrier","year":"1995","journal-title":"J. Appl. Physiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1152\/jappl.1964.19.4.713","article-title":"Distribution of Blood Flow in Isolated Lung; Relation to Vascular and Alveolar Pressures","volume":"19","author":"West","year":"1964","journal-title":"J. Appl. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1097\/00006123-200211000-00023","article-title":"Cerebral venous steal: Blood flow diversion with increased tissue pressure","volume":"51","author":"Pranevicius","year":"2002","journal-title":"Neurosurgery"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Pranevicius, M., Pranevicius, H., and Pranevicius, O. (2021). Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-85931-x"},{"key":"ref_7","first-page":"40","article-title":"Electrical Circuit Model of Fractional Flow Reserve in Cerebrovascular Disorders","volume":"20","author":"Pranevicius","year":"2014","journal-title":"Elektron. Elektrotechnika"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3183","DOI":"10.1161\/01.CIR.92.11.3183","article-title":"Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow","volume":"92","author":"Pijls","year":"1995","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1113\/jphysiol.1914.sp001669","article-title":"On the mechanical factors which determine the output of the ventricles","volume":"48","author":"Patterson","year":"1914","journal-title":"J. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/j.1440-1681.1986.tb00928.x","article-title":"Relation of intramyocardial pressure to coronary pressure at zero flow","volume":"13","author":"Sabbah","year":"1986","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100117","DOI":"10.1016\/j.medntd.2022.100117","article-title":"Application of multiscale coupling models in the numerical study of circulation system","volume":"14","author":"Chi","year":"2022","journal-title":"Med. Nov. Technol. Devices"},{"key":"ref_12","unstructured":"Pranevicius, M., Pranevicius, H., and Pranevicius, O. (2022). Apparatus to Diagnose and Treat Intracranial Circulation. (20220322955-A1), U.S. Patent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1161\/01.STR.6.1.58","article-title":"Skin blood pressure in the forehead in patients with internal carotid lesions","volume":"6","author":"Nielsen","year":"1975","journal-title":"Stroke"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1161\/01.STR.20.8.1012","article-title":"Doppler ophthalmic blood pressure measurement in the hemodynamic evaluation of occlusive carotid artery disease","volume":"20","author":"Strauss","year":"1989","journal-title":"Stroke"},{"key":"ref_15","first-page":"723","article-title":"Directional Doppler studies of supraorbital artery flow in internal carotid stenosis and occlusion","volume":"76","author":"LoGerfo","year":"1974","journal-title":"Surgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/BF02221749","article-title":"Supraorbital artery as an alternative site for oscillometric blood pressure measurement","volume":"12","author":"Lee","year":"1996","journal-title":"J. Clin. Monit."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.pneurobio.2017.11.001","article-title":"Cerebral venous collaterals: A new fort for fighting ischemic stroke?","volume":"163\u2013164","author":"Tong","year":"2018","journal-title":"Prog. Neurobiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1161\/01.CIR.87.4.1354","article-title":"Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty","volume":"87","author":"Pijls","year":"1993","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.injury.2007.09.029","article-title":"Utility of optic nerve ultrasonography in head injury","volume":"39","author":"Goel","year":"2008","journal-title":"Injury"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3171\/jns.1997.87.1.0034","article-title":"Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests","volume":"87","author":"Hansen","year":"1997","journal-title":"J. Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1076\/stra.9.1.13.711","article-title":"Ophthalmodynamometry: A reliable method for measuring intracranial pressure","volume":"9","author":"Motschmann","year":"2001","journal-title":"Strabismus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1212\/WNL.0b013e3182574f50","article-title":"Clinical assessment of noninvasive intracranial pressure absolute value measurement method","volume":"78","author":"Ragauskas","year":"2012","journal-title":"Neurology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1002\/jum.15599","article-title":"Role of Doppler Ultrasound Analysis of Blood Flow Through the Ophthalmic and Intracranial Arteries in Predicting Neurologic Symptoms During Carotid Endarterectomy","volume":"40","author":"Franjic","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.hlc.2008.04.009","article-title":"Does combined antegrade-retrograde cardioplegia have any superiority over antegrade cardioplegia?","volume":"17","author":"Radmehr","year":"2008","journal-title":"Heart Lung Circ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/bc.bc_88_22","article-title":"Research progress of selective brain cooling methods in the prehospital care for stroke patients: A narrative review","volume":"9","author":"Chen","year":"2023","journal-title":"Brain Circ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.xjon.2022.07.007","article-title":"Neuroprotective effect of selective hypothermic cerebral perfusion in extracorporeal cardiopulmonary resuscitation: A preclinical study","volume":"12","author":"Zhai","year":"2022","journal-title":"JTCVS Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"272","DOI":"10.3171\/jns.2004.100.2.0272","article-title":"Rapid and selective cerebral hypothermia achieved using a cooling helmet","volume":"100","author":"Wang","year":"2004","journal-title":"J. Neurosurg."},{"key":"ref_28","first-page":"950524","article-title":"Lower body positive pressure application with an antigravity suit in acute carotid occlusion","volume":"2010","author":"Berthet","year":"2010","journal-title":"Stroke Res. Treat."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Tajeddini, F., Nikmaneshi, M.R., Firoozabadi, B., Pakravan, H.A., Ahmadi Tafti, S.H., and Afshin, H. (2020). High precision invasive FFR, low-cost invasive iFR, or non-invasive CFR?: Optimum assessment of coronary artery stenosis based on the patient-specific computational models. Int. J. Numer. Method. Biomed. Eng., 36.","DOI":"10.1002\/cnm.3382"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/672\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:11:10Z","timestamp":1760029870000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/672"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,6]]},"references-count":29,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040672"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040672","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,4,6]]}}}