Treatment of ischemia due to "steal" by arteriovenous fistula with distal artery ligation and revascularization.

Three cases are described of upper extremity ischemia occurring after the creation of fistulas (AVFs) (one case) and bridge AVFs (two cases) for hemodialysis access. All three cases were successfully treated with ligation of the artery immediately distal to the origin of the AVF in conjunction with a reversed saphenous vein bypass. The latter was constructed from the artery proximal to the origin of the fistula to the artery distal to the site of ligation. Preoperative and postoperative hemodynamic measurements and complete disappearance of symptoms indicated that this procedure corrected the ischemic steal phenomenon. Angioaccess function was not affected in these three cases, thereby allowing continuation of its use immediately after corrective surgery and for follow-up periods of 1 month, 6 months, and 8 years.