Ischemic steal syndrome in a hemodialysis patient: The roles of Doppler ultrasonography and dynamic Doppler studies in diagnosis and treatment selection

Ischemic steal syndrome (ISS) is a complication that can occur after the construction of a vascular access for hemodialysis. It is characterized by ischemia of the hand caused by marked reduction or reversal of flow through the arterial segment distal to the arteriovenous fistula (AVF). The diagnosis of hand ischemia is based on physical examination, but imaging studies are very useful for detecting the true cause of ischemia and for selecting an appropriate therapeutic strategy. In this report, we describe an uncommon cause of ISS in a patient on hemodialysis. The ischemia was caused by the presence of undetected flow through an older AVF on the same arm as the AVF used for dialysis. The unsuspected “steal” was disclosed by color Doppler examination of the vascular bed of the patient’s left arm. Dynamic Doppler studies then played a fundamental role in the decision to ligate the distal radio-cephalic AVF. The procedure led to the complete relief of ischemic symptoms.