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Steal Syndrome — ESENeph MCQ

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ModerateHaemodialysisSteal SyndromeESENeph

A 62-year-old man on haemodialysis via a brachiocephalic AV fistula develops a cool, painful hand during dialysis. The hand improves when the fistula is compressed. Pulse oximetry shows reduced saturations in the affected fingers during dialysis. What is the diagnosis?

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Correct answer: C — Steal syndrome

Steal syndrome occurs when the AV fistula diverts blood from the distal limb, causing ischaemia. Symptoms include pain, coolness, and reduced perfusion of the hand/fingers, which worsen during dialysis (when fistula flow increases) and improve with fistula compression (restoring distal flow). It is more common with proximal (brachial artery-based) fistulae. Management includes surgical flow reduction (banding, DRIL procedure, or proximalization of arterial inflow).

Reference: UKKA 2019 – Vascular Access Guideline; ERA-EDTA 2019 – VA Guideline