Prevention better than cure. Avoiding steal syndrome with proximal radial or ulnar arteriovenous fistulae

Steal syndrome is a significant complication of arteriovenous fistulae (AVF). We wanted to assess an alternative technique to reduce the incidence of steal syndrome and add an extra option for vascular access for long-term hemodialysis patients

All patients who underwent proximal radial or ulnar artery AVF between 2003 and 2007 were evaluated retrospectively.

There were 58 patients, 35 men and 23 women, and the median age was 60 years (range 19-85 years). The proximal radial artery was used in 50 (89%) of cases and the ulnar artery in 8. Three fistulae (5%) failed in the first week, 3 others failed later, prior to use leading to a 90% successful patency rate. One diabetic patient developed steal syndrome and re-presented to the surgeons at a late stage when they had finger ulceration and it was decided to ligate the fistula in this case. Thus, the overall incidence of steal syndrome was low at 2%.

It is suggested that arterio-venous fistulae using proximal radial or ulnar arteries can be performed before brachio-cephalic fistulae since they offer long-term patency and reduced incidence of steal syndrome. Brachio-cephalic AVF can be performed subsequently if necessary.