Dialysis access-associated hand ischemia, known as 'steal syndrome,' affects 1%-20% of accesses, primarily impacting upper arm arteriovenous fistulas (AVFs). Symptoms include hand numbness, cold sensations, and diminished pulses, while diagnosis may involve temperature comparison and pulse oximetry. Treatment varies from conservative measures like wearing gloves to surgical options aimed at preserving or, in severe cases, ligating vascular access.

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