Arterial Steal Syndrome: A Modest Proposal for an Old Paradigm

Arteriovenous Access and Hand Pain

“…In this context, the appearance of a radial pulse with access occlusion would indicate that the arteriovenous access was stealing too much blood away from the forearm, creating ischemia, and flow reduction through the access was indicated. Although logical, findings of a recent study cast doubt on this notion (10). In this report, a majority (91%; n ϭ 12) of patients showed pulse with access occlusion, yet only a minority (18%) of patients were found to be candidates for a flow-reduction procedure after a more detailed evaluation.…”

“…In patients who are on chronic dialysis, however, the onset may be insidious and delayed for days, weeks, and even months. In one study, time of onset of symptoms was found to be 8 Ϯ 2 mo from the time of access creation (10). In this study, the duration of symptoms was 2 Ϯ 0.5 mo at the time of diagnosis.…”

“…In this study, the duration of symptoms was 2 Ϯ 0.5 mo at the time of diagnosis. Although symptoms have been known to resolve with time as a result of the development of collateral circulation, deterioration in the severity of clinical features, perhaps as a result of progression of arterial occlusive lesions, also has been reported (10).…”

“…Good arteriography is the most important tool in making the diagnosis as well as developing a treatment strategy for DHIS (10). This can be achieved by digital subtraction angiography (DSA).…”

“…It has been demonstrated that in dialysis patients, current smoking is predictive of peripheral arterial disease and future cardiovascular events (21). In one series of patients who presented with hand ischemia, Ͼ90% gave a history of smoking (current smokers 58%; former smokers 34%) (10). Smoking cessation is beneficial (57) and should be strongly encouraged in these cases.…”