Radial Steal in a Arterio-venous Fistula

Steal syndrome following arteriovenous fistula formation is an uncommon complication. Steal syndrome is described as symptomatic steal phenomenon that results in an ischemic hand. Patients usually complain of a cool, tingling hand, and rarely have ischemic lesions. The steal syndrome has resulted in vascular insufficiency and even amputation of the limb [1] Steal phenomenon occurs when blood that normally supplies a particular area is diverted from that area to another. In patients with radial steal syndrome, flow through the ulnar artery provides inflow to the hand via the palmar arch while providing some retrograde flow to the fistula via the radial artery. This reversal of flow is not usually clinically significant, and rarely results in a steal syndrome. Steal syndrome is more prevalent in patients with side to side anastomosis. An end-to-side anastomosis may prevent the steal phenomenon. At sonographic examination, the distal radial artery flow direction is reversed or, rarely, occluded Brief manual compression of the graft while insonating the distal radial artery will usually demonstrate flow reversal, with the radial artery resuming its normal high-resistance pattern toward the hand [2]