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A Radial Steal Syndrome with Arteriovenous Fistula for Hemodialysis: Studies in Seven Patients

J. A. BUSSELL, M.D.; J. A. ABBOTT, M.D.; and R. C. LIM, M.D.
[+] Article, Author, and Disclosure Information

Supported in part by the Northern California Regional Dialysis Center of the California Department of Public Health, San Francisco, Calif. Dr. Bussell is the recipient of General Research Support Award FR-05356-09, University of Southern California, Los Angeles, Calif.

▸Requests for reprints should be addressed to Joseph A. Abbott, M.D., Cardio-Pulmonary Laboratory, San Francisco General Hospital, San Francisco, Calif. 94110

San Francisco, California

Ann Intern Med. 1971;75(3):387-394. doi:10.7326/0003-4819-75-3-387
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Creating an arteriovenous fistula between artery and vein provides a subcutaneous approach for chronic hemodialysis and has become a popular alternative to external shunts. In seven patients with a side-to-side radial-cephalic arteriovenous anastomosis, digital and forearm blood flow was measured by pneumatic plethysmography. Blood flow was always increased in the forearm and always decreased in the thumb of the fistula extremity. All but one patient had related symptoms of arterial insufficiency. Arteriograms documented the presence of a radial fistula "steal" syndrome. In every subject an increase in thumb pulsation was recorded with temporary radial artery occlusion distal to the fistula; the maneuver prevented the steal complex and directed blood flow into the hand. An end-to-side anastomosis may prevent the steal phenomenon.





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