Severe steal develops immediately following AV bridge grafting and patients should be closely monitored during the first 24 h; surveillance is not indicated beyond 1 month. In contrast, steal following formation of proximal autogenous fistulae may be either of immediate or of 'late' onset, months or years after the creation of the fistulae, and lifelong monthly surveillance is recommended. Close monitoring is also recommended after any subsequent surgical or interventional correcting procedure for all access types. DRIL is the procedure of choice in limb-threatening severe steal.

Surgical repair can be performed in school-aged children as in adults. Surgical treatment of arterial injuries in neonates, infants, and those children <2.5 years old might best be deferred in ischemic but nonthreatened limbs. In a nonthreatened ischemic extremity in this age group, systemic heparinization is an alternative safe method of management. Limb loss is rare if distal Doppler signals are present; but as children grow, limb shortening is a threat. In preschool children, the risks of an open surgical repair must be weighed against any potential benefits.

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