Irreversible sequela in an arterial venous fistula with steal syndrome: a case study.

Arteriovenous fistulas may be susceptible to steal syndrome from a variety of conditions. Steal syndrome is defined as arterial insufficiency distal to the arteriovenous fistula. The causality of the insufficiency may include arterial disease proximal or distal to the fistula, markedly high blood flow volume after creation, or undetected collateral flow. Prior arterial disease may expose insufficient profusion to the distal extremity after fistula creation. High blood flow volume immediately after fistula creation may perhaps cause steal syndrome symptoms, but this often resolves with fistula maturation. Undetected collateral flow, or side branches, from target vessels receive increased blood volume after fistula creation and expand, thereby stealing blood flow from the hand. This particular condition can potentially cause ischemic changes distal to the fistula with potentially irreversible sequela if not recognized in a timely manner. A sixty- one year old male, sent with chest pain to the emergency room from his dialysis center, was found to have steal syndrome with an accompanying motor deficit. The diagnosis of steal syndrome is based on physical examination, patient history, and confirmation testing such as doppler ultrasound, digital pressures or arteriogram. A thorough preoperative workup and careful postoperative monitoring can minimize steal syndrome and prevent permanent impairment.