Steal syndrome • Dialysis access–associated hand ischemia, “steal syndrome,” complicates 1%–20% of accesses • Is stealing سرقة of (arterial) blood which would normally flow to the palmar arch. • Common in upper arm AVFs (~4%) compared with both AVGs and forearm AVFs (~1%). • Risk factors  Upper arm access  Peripheral arterial disease  Diabetes • Patient can complain of:  Hand numbness, pain, or weakness  Cold sensation and pale or cyanosis of the fingers  Diminished or absent pulses  Ulceration or dry gangrene of the finger tips  in severe cases  infection.  Pt start to wear gloves in fistula hand • Examination requires comparison with the temperature, pulse, and function of the opposite hand. • Investigations  Pulse oximetry  Doppler flow  Angiography • Differential diagnosis  Carpal tunnel syndrome  Peripheral vascular disease  Neuropathy DM or Uremia  Nerve trauma  Ischemic monomelic neuropathy due to the loss of blood supply to nerves. • Treatment Options (Depending on Severity)  Symptomatic coldness or paresthesia but without sensory or motor loss (e.g., gloves)  Surgical, with preservation of vascular access- in "steal” effect (pain at rest) or the appearance of nonhealing ulcers: banding to reduce flow, distal revascularization–interval ligation (DRIL) procedure  Surgical, with loss of vascular access- in motor loss: ligation

2. Definition
 Dialysis access–associated hand ischemia, “steal syndrome,”
complicates 1%–20% of accesses
 Is stealing of (arterial) blood which would normally flow to the
palmar arch.
 Common in upper arm AVFs (~4%) compared with both AVGs
and forearm AVFs (~1%).

3. Risk factors
Upper arm access (AVFs)
Peripheral arterial disease
Diabetes

4. Symptoms
Hand numbness, pain, or weakness
Cold sensation and pale or cyanosis of the fingers
Diminished or absent pulses
Ulceration or dry gangrene of the finger tips  in severe
cases  infection.
Patient start to wear gloves in fistula hand

5. Diagnosis
 Examination requires comparison with the temperature,
pulse, and function of the opposite hand.
 Investigations
 Pulse oximetry
 Doppler flow
Angiography

6. Differential diagnosis
Carpal tunnel syndrome
Peripheral vascular disease
Neuropathy DM or Uremia
Ischemic monomelic neuropathy due to the loss of
blood supply to nerves.

7.  Treatment Options (Depending on Severity)
Symptomatic coldness or paresthesia but without sensory or
motor loss (e.g., gloves)
Surgical, with preservation of vascular access- banding to
reduce flow, distal revascularization–interval ligation (DRIL)
procedure
Surgical, with loss of vascular access- in motor loss: ligation