Vascular access steal syndrome
In nephrology, vascular access steal syndrome is a syndrome caused by ischemia (not enough blood flow) resulting from a vascular access device (such as an arteriovenous fistula or synthetic vascular graft–AV fistula) that was installed to provide access for the inflow and outflow of blood during hemodialysis.

Signs
Pallor
Diminished pulses (distal to the fistula)
Necrosis
Decreased wrist-brachial index (ratio of blood pressure measured in the wrist and the blood pressure measured in the upper arm), especially if below 0.6

Symptoms
Pain distal to the fistula.Symptoms are graded by their severity:
Grade 0: No symptoms of steal
Grade 1: Mild - cool extremity, improvement in hand pulse with access occlusion
Grade 2: Moderate - Ischemic symptoms during dialysis
Grade 3: Severe - Ischemic hand pain outside of dialysis; Ulcers or gangrene of the fingers

Diagnosis
History and physical exam - relief of symptoms with compression of the fistula on exam is highly suggestive of steal
Arteriography
Duplex ultrasound

Treatment
The fistula flow can be restricted through banding, or modulated through surgical revision.

Revascularization techniques
Distal Revascularization and Interval Ligation (DRIL) procedure
PAI (Proximalization of the Arterial Inflow)
RUDI (Revision Using Distal Inflow)

Banding techniques
Narrowing suture
Plication
Minimally invasive MILLER banding
Tapering
Surgical bandingIf the above methods fail, the fistula is ligated, and a new fistula is created in a more proximal location in the same limb, or in the contralateral limb.

Incidence
DASS occurs in about 1% of AV fistulas and 2.7-8% of PTFE grafts.

Terminology
Within the contexts of nephrology and dialysis, vascular access steal syndrome is also less precisely just called steal syndrome (for short), but in wider contexts that term is ambiguous because it can refer to other steal syndromes, such as subclavian steal syndrome or coronary steal syndrome.

See also
Terms for anatomical location


== References ==