Vascular access steal syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: Steal syndrome

Overview

In nephrology, vascular access steal syndrome, also known less precisely as steal syndrome, refers to vascular insufficiency resulting from a poorly constructed arteriovenous fistula (Cimino fistula, or synthetic vascular graft-AV fistula).

History and Symptoms

  • Pain distal to the fistula.

Physical Examination

  • Pallor
  • Diminished pulses (distal to the fistula)
  • Necrosis[1]
  • Decreased wrist-brachial index (ratio of blood pressure measured in the wrist and the blood pressure measured in the upper arm)

Diagnosis

Treatment

  • Access ligation/vein banding (banding of the fistula or a vessel distal to the fistula to restrict flow through the fistula)

References

  1. Porcellini M, Selvetella L, De Rosa P, Baldassarre M, Bauleo A, Capasso R. "[Hand ischemia due to "steal syndrome" in vascular access for hemodialysis]". G Chir. 18 (1–2): 27–30. PMID 9206477.
  2. Asif A, Leon C, Merrill D, Bhimani B, Ellis R, Ladino M, Gadalean F (2006). "Arterial steal syndrome: a modest proposal for an old paradigm". Am J Kidney Dis. 48 (1): 88–97. PMID 16797390.

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