Surgical treatment of "steal syndrome" induced by arteriovenous grafts for hemodialysis.

OBJECTIVE: A rare but serious complication of angioaccess surgery for hemodialysis is the so called steal syndrome presenting as ischemia distal to an arteriovenous fistula. The main problem of various surgical techniques to correct steal is subsequent thrombosis of the fistula or persistence of distal ischemia. INTERVENTIONS: This paper describes an unknown technique for correction of ischemic steal consisting of ligation of the artery just distal to the take-off of the fistula and arterial bypass from the artery proximal to the take-off of the fistula to the artery distal to ligation. PATIENTS: Six patients with chronic renal insufficiency (3 male, 3 female) with patent upper arm cephalic fistulas presented with severe hand ischemia. RESULTS: Symptoms improved in all 6 patients immediately after operation. Successful hemodialysis could be maintained using the original fistula. CONCLUSIONS: The described technique is maybe the procedure of choice for the correction of fistula induced ischemic steal.