Concomitant Staple Aneurysmorrhaphy and Flow-Calibrated Arteriovenous Fistula Banding Over a Coronary Dilator to Treat Hand Steal Syndrome

Background: True venous aneurysm formation can occur in patients with arteriovenous fistulas (AVFs) for hemodialysis but association with steal syndrome is uncommon. Methods: To describe a case of a patient on chronic hemodialysis through a right brachiocephalic fistula, who presents with associated steal syndrome and true arteriovenous access aneurysm. Results: A 34-year-old female with true AVF aneurysm presented with hand steal syndrome confirmed by noninvasive studies. The patient underwent a successful vein aneurysmorrhaphy with a commercially available stapler device and duplex ultrasound flow-calibrated banding. At 1-year follow-up, she remains pain free and the fistula remains functional with no recurrence of venous aneurysmal degeneration. Conclusion: The use of a commercially available surgical stapler devices along with flow-calibrated banding guided by duplex ultrasound over a coronary dilator during the same operation is an elegant, efficacious, and a durable alternative for patients with hand steal syndrome and concomitant AVF aneurysms.