Treatment of Ischemic Steal Syndrome in a Patient With Aberrant Arterial Anatomy Following Dialysis Access Surgery

Symptomatic ischemic steal syndrome (ISS) is a complex complication that develops in a small number of patients who have undergone a dialysis access procedure. This report describes the case of a 44-year-old female with aberrant upper extremity arterial anatomy who developed ISS following a radio-cephalic fistula. Ultrasound evaluation revealed abnormal blood flow in the radial artery and identified a communication between the radial and ulnar arteries distal to the anastomosis of the arteriovenous fistula. These findings assisted with the development of a surgical plan to ligate the intervening radial artery which resulted in resolution of the ISS symptoms.