Treatment of steal syndrome in patients with arteriovenous fistula: Narrowing the arterial part of anastomosis

If primary vascular access fails, secondary and tertiary vascular accesses in the proximal sides are needed in patients undergoing hemodialysis due to end-stage renal disease. Unfortunately, the risk of steal syndrome is higher, if the vascular access is created in the proximal sides. Although steal syndrome is rare, it is a potentially devastating complication. Herein, we present two cases of steal syndrome which was treated by narrowing the arterial part of the anastomosis. With the anastomotic narrowing technique which we used, ischemic symptoms of the first case regressed completely, and wound healing was achieved after some time. Ischemic symptoms of the second case also regressed completely with pain relief. Arteriovenous fistulas (AVFs) of both cases were preserved, and the patients underwent hemodialysis through the AVFs for 40 and 21 months, respectively. We believe that narrowing the arterial part of the anastomosis under the intraoperative color Doppler ultrasonography guidance is a simple technique which does not require the use of any foreign materials, and it may be effective in patients with steal syndrome due to a high-flow rate and a large anastomosis, not due to peripheral arterial disease.