Dialysis access-associated steal syndrome: The role of ultrasonography

Background: Ischemic steal syndrome is an infrequent, but potentially disabling complication of hemodialysis (HD) access creation. We analyzed the ability of duplex Doppler ultrasonography to reveal potential causes of ischemic steal syndrome in antebrachial accesses. Methods: We performed 212 examinations on 121 patients. Ten patients suffered from ischemic steal syndrome. Complete length access evaluation was performed by a linear array 7.5 MHz ultrasound probe. Results: Hand ischemia was explained by inflow artery stenosis in five cases. Excessive fistula flow due to large arteriovenous anastomosis was the suspected cause in two cases. The remaining two cases were characterized by high-resistant minimal flow in the ulnar artery with bi-directional flow in the distal part of the radial artery, suggesting stenoses located in the arcus palmaris. Duplex Doppler ultrasound had not revealed the etiology of clinically apparent hand ischernia in one case. Isolated inflow artery stenoses were treated successfully by percutaneous transluminal angioplasty. Patients with ischemic steal syndrome and high fistula flow were treated successfully by outflow vein banding. Conclusions: Duplex Doppler ultrasonography is a valuable tool for diagnosing the cause of ischemic steal syndrome and can probably replace angiography in some cases.