Vascular steal syndrome occurring 20 years after surgical arteriovenous fistula formation: an unusual cause of loss of hand function

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

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Vascular Steal Syndrome Related to an Arteriovenous Fistula (AVF) can be Treated by Simple Plication of the Venous Inflow

Journal of Surgical Research ◽

10.1016/j.jss.2011.11.987 ◽

2012 ◽

Vol 172 (2) ◽

pp. 349

Author(s):

M.S. Patel ◽

T. Street ◽

G. Nassar ◽

M.G. Davies ◽

E.K. Peden ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Steal ◽

Steal Syndrome

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Radio-median cubital / radiocephalic arteriovenous fistula at elbow to prevent vascular steal syndrome associated with brachiocephalic fistula: Review of 320 cases

Indian Journal of Urology ◽

10.4103/0970-1591.33721 ◽

2007 ◽

Vol 23 (3) ◽

pp. 261 ◽

Cited By ~ 5

Author(s):

Anant Kumar ◽

MrigankS Jha ◽

Manish Singla ◽

Nitin Gupta ◽

Pamposh Raina ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Steal ◽

Steal Syndrome ◽

Brachiocephalic Fistula

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Open Repair and Venous Inflow Plication of the Arteriovenous Fistula Is Effective in Treating Vascular Steal Syndrome

Annals of Vascular Surgery ◽

10.1016/j.avsg.2014.12.042 ◽

2015 ◽

Vol 29 (5) ◽

pp. 927-933 ◽

Cited By ~ 5

Author(s):

Mitul S. Patel ◽

Mark G. Davies ◽

George M. Nassar ◽

Joseph J. Naoum

Keyword(s):

Arteriovenous Fistula ◽

Open Repair ◽

Vascular Steal ◽

Steal Syndrome

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Feasibility of a 3 mm arteriotomy for brachiocephalic fistula formation

The Journal of Vascular Access ◽

10.1177/1129729820959930 ◽

2020 ◽

pp. 112972982095993

Author(s):

Jeremy Crane ◽

Safa Salim ◽

Rowland Storey

Keyword(s):

Arteriovenous Fistula ◽

Primary Patency ◽

Fistula Formation ◽

Secondary Patency ◽

Dialysis Access ◽

Hammersmith Hospital ◽

History Of ◽

Steal Syndrome ◽

Brachiocephalic Fistula

Background: The arteriovenous fistula is the modality of choice for long-term haemodialysis access. We describe the feasibility of routinely fashioning a brachiocephalic fistula utilising a 3 mm long arteriotomy in an attempt to reduce the incidence of symptomatic steal syndrome yet while maintaining satisfactory clinical outcomes. Methods: All patients who underwent brachiocephalic fistula formation using a routine 3 mm long arteriotomy within Hammersmith Hospital between January 2017 and March 2018 were included. Primary outcomes included primary failure, failure of maturation, secondary patency and steal syndrome. Results: Sixty-eight brachiocephalic arteriovenous fistula were fashioned utilising a 3 mm long arteriotomy during the study period. Mean age was 60.5 years with 59% having a history of diabetes mellitus. Mean followup was 368 days. Primary failure occurred in 10 (14.7%) patients. Cannulation was achieved in 67.3% of remaining fistula within 3-months, rising to 87.3% by 6-months. Primary patency at 6 and 12 months was 76% and 69%, respectively. Secondary patency at 6 and 12 months was 94% and 91%, respectively. Dialysis access steal syndrome was clinically apparent in three (4.4%) patients with all cases being managed conservatively. Conclusion: A 3 mm long arteriotomy may be routinely utilised for brachiocephalic fistula creation in an attempt to limit the incidence of steal syndrome yet while maintaining clinical patency outcomes.

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Does a failed DRIL mean the end for a fistula? A case report in the use of an Amplatzer plug post DRIL procedure for ongoing steal syndrome

The Journal of Vascular Access ◽

10.1177/11297298211006992 ◽

2021 ◽

pp. 112972982110069

Author(s):

Gemma Fitzpatrick ◽

Philip Kiely ◽

Bora Jeong ◽

Ewan Macaulay

Keyword(s):

Case Report ◽

Arteriovenous Fistula ◽

Ulnar Artery ◽

Hybrid Procedure ◽

Fistula Formation ◽

Dialysis Access ◽

Retrograde Flow ◽

Occlusion Device ◽

Steal Syndrome

Dialysis access steal syndrome is a well-recognised complication, affecting 1%–8% of all patients who undergo arteriovenous fistula formation particularly those that are brachial based. We present a case of ongoing steal syndrome following a DRIL procedure via retrograde flow in the ulnar artery. This was managed via a hybrid procedure and the use of an Amplatzer plug. This case demonstrates a novel use for the Amplatzer occlusion device, it is also a reminder that failure to occlude the vessel close to the fistula anastomosis can result in continued steal despite a functioning DRIL bypass.

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