Arteriography in a patient with symptoms of arterial steal syndrome.

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Presentation transcript:

Arteriography in a patient with symptoms of arterial steal syndrome. Arteriography in a patient with symptoms of arterial steal syndrome. Arrows indicate the direction of blood flow. The short bold arrow indicates 60% stenosis of the artery just proximal to the anastomosis. The long bold arrow shows a juxta-anastomotic venous stenosis. Even this stenosis was not able to protect the patient against hand ischemia. Retrograde flow was noted through the radial artery into the access. Physical examination could confirm the retrograde filling of the radial artery by occluding the ulnar artery and performing palpation of the radial artery. This patient showed a good radial and ulnar artery pulse on physical examination yet had hand ischemia. This case required an axillary loop fistula (proximalization procedure) using the outflow of the existing fistula. RA, radial artery; UA, ulnar artery; CVAVF, cephalic vein arteriovenous fistula. Reprinted from reference (10), with permission. Carlos Leon, and Arif Asif CJASN 2007;2:175-183 ©2007 by American Society of Nephrology