Venous aneurysm development in left upper limb brachiocephalic arteriovenous fistula with manifestations of steal syndrome: a case report
DOI:
https://doi.org/10.18203/2349-2902.isj20251910Keywords:
Steal syndrome, Arteriovenous fistula, Hemodialysis, Vascular access, IschemiaAbstract
Steal syndrome is a rare but significant complication of arteriovenous fistulas (AVF), characterized by distal limb ischemia due to blood diversion from the arterial circulation into the low-resistance venous side of the AVF. This phenomenon can lead to symptoms such as pain, pallor, and compromised tissue perfusion, requiring careful diagnosis and management. To describe the diagnosis, surgical management, and clinical outcome of a patient with a dysfunctional AVF due to steal syndrome in the context of hemodialysis (HD), emphasizing the importance of early diagnosis and surgical planning to prevent complications such as distal ischemia and access dysfunction. A 42-year-old female with a longstanding history of end-stage renal disease (ESRD) and HD presented with a progressively enlarging, painful left brachiocephalic AVF. She exhibited symptoms of steal syndrome, including palpitations and tachycardia during dialysis. Diagnostic imaging revealed a dysfunctional AVF with a venous aneurysm, necessitating surgical intervention for correction.
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Alqahtani SS, Aljaber FK, Alsuwailem BY, AlMashouq YA, AlHarbi BG, Elawad AM. Dialysis Access-Associated Steal Syndrome in High-Risk Patients Undergoing Surgery for Hemodialysis Access: A Systematic Review and Meta-Analysis of Preventive Operative Techniques. Cureus. 2025;15(11):e49612.
Stoecker JB, Li X, Clark TWI, Mantell MP, Trerotola SO, Vance AZ. Dialysis Access-Associated Steal Syndrome and Management. Cardiovasc Intervent Radiol. 2023;46(9):1168-81. DOI: https://doi.org/10.1007/s00270-023-03462-6
Síndrome de hipoperfusión distal (Síndrome de robo) de la Fístula arteriovenosa. 2025. Available at: https://www.nefrologiaaldia.org/es-articulo-sindrome-de-hipoperfusion-distal-sindrome-de-robo-de-la-fistula-arteri-285. Accessed on 12 May 2025.
Mascia S, Spiezia S, Assanti A, De Nicola L, Stanzione G, Bertino V, et al. Ischemic steal syndrome in a hemodialysis patient: The roles of Doppler ultrasonography and dynamic Doppler studies in diagnosis and treatment selection. J Ultrasound. 2010;13(3):104-6. DOI: https://doi.org/10.1016/j.jus.2010.09.003
Tordoir JHM, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2004;27(1):1-5. DOI: https://doi.org/10.1016/j.ejvs.2003.10.007
Kang K, Lee JH, Hwang HP, Kaliannagounder VK, Park CH, Kwak HS. Quantification of steal flow on Doppler ultrasound in patients with arteriovenous graft for hemodialysis. Vascular. 2015;33(3):623-31. DOI: https://doi.org/10.1177/17085381241254566
Papadoulas SI, Theodoropoulou T, Kouri N, Tsimpoukis A, Kitrou P, Papachristou E, et al. Treatment of Dialysis Access Steal Syndromewith Concomitant Vascular Access Aneurysms. Vasc Spec Int. 2022;38:11. DOI: https://doi.org/10.5758/vsi.220006
Crane J, Salim S, Storey R. Feasibility of a 3 mm arteriotomy for brachiocephalic fistula formation. J Vasc. 2021;22(5):697-700. DOI: https://doi.org/10.1177/1129729820959930
Shemesh D, Mabjeesh NJ, Abramowitz HB. Management of dialysis access–associated steal syndrome: Use of intraoperative duplex ultrasound scanning for optimal flow reduction. J Vasc Surg. 1999;30(1):193-5. DOI: https://doi.org/10.1016/S0741-5214(99)70192-8
Lee H, Thomas SD, Paravastu S, Barber T, Varcoe RL. Dynamic Banding (DYBAND) Technique for Symptomatic High-Flow Fistulae. Vasc Endovascular Surg. 2020;54(1):5-11. DOI: https://doi.org/10.1177/1538574419874934
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