Of note, the demonstration of retrograde flow on CDUS evaluation of an AV access does not reliably predict or provide the presence of a clinical steal syndrome. While hemodynamic findings of arterial steal can be illustrated in most patients with forearm as well as proximal AV accesses, development of ischemic symptoms occurs in a small fraction of cases. An array of noninvasive investigations along with duplex US such as digital/brachial index measurements, transcutaneous oxygen saturation, and digital plethysmography may assist in helping to evaluate patients that demonstrate symptoms suggestive of arterial steal [133]. CTA Extremity Area of Interest With IV Contrast While not associated with widespread use in the evaluation of DASS or DHIS, CTA represents a less invasive imaging option for the extremity arteries [133]. MDCT technology has allowed CTA to reliably assess the peripheral arteries in the upper and lower extremities [133]. MDCT is associated with the advantages of high spatial resolution, fast scan times, augmented anatomic coverage, and the capacity for generation of high-quality multiplanar reformats and 3-D renderings from raw data that can be expeditiously reprocessed. CTV Extremity Area of Interest With IV Contrast There is no identifiable relevant literature to support the use of CTV extremity in evaluation of suspected vascular steal. MRA Extremity Area of Interest Without and With IV Contrast Dujim et al [12] reported a study assessing the role of CE-MRA in the evaluation of inflow lesions, where 13 patients were evaluated, of which 2 were referred due to symptoms of steal. In this study, 7 of the 13 patients revealed arterial stenoses while 6 patients demonstrate additional stenoses regional to the shunt and/or outflow. Aside from standard DSA of the shunt and outflow, inflow DSA evaluation was accomplished by catheterization in every case where the CE-MRA exhibited a stenotic inflow lesion.
Dialysis Fistula Malfunction. Of note, the demonstration of retrograde flow on CDUS evaluation of an AV access does not reliably predict or provide the presence of a clinical steal syndrome. While hemodynamic findings of arterial steal can be illustrated in most patients with forearm as well as proximal AV accesses, development of ischemic symptoms occurs in a small fraction of cases. An array of noninvasive investigations along with duplex US such as digital/brachial index measurements, transcutaneous oxygen saturation, and digital plethysmography may assist in helping to evaluate patients that demonstrate symptoms suggestive of arterial steal [133]. CTA Extremity Area of Interest With IV Contrast While not associated with widespread use in the evaluation of DASS or DHIS, CTA represents a less invasive imaging option for the extremity arteries [133]. MDCT technology has allowed CTA to reliably assess the peripheral arteries in the upper and lower extremities [133]. MDCT is associated with the advantages of high spatial resolution, fast scan times, augmented anatomic coverage, and the capacity for generation of high-quality multiplanar reformats and 3-D renderings from raw data that can be expeditiously reprocessed. CTV Extremity Area of Interest With IV Contrast There is no identifiable relevant literature to support the use of CTV extremity in evaluation of suspected vascular steal. MRA Extremity Area of Interest Without and With IV Contrast Dujim et al [12] reported a study assessing the role of CE-MRA in the evaluation of inflow lesions, where 13 patients were evaluated, of which 2 were referred due to symptoms of steal. In this study, 7 of the 13 patients revealed arterial stenoses while 6 patients demonstrate additional stenoses regional to the shunt and/or outflow. Aside from standard DSA of the shunt and outflow, inflow DSA evaluation was accomplished by catheterization in every case where the CE-MRA exhibited a stenotic inflow lesion.