From the Guidelines
If you're experiencing weakness, pain, and cold skin in your forearm and hand after fistula placement, you should contact your healthcare provider immediately as these symptoms may indicate a complication called steal syndrome, which can lead to severe morbidity and mortality if left untreated 1. This condition occurs when blood is diverted away from your hand due to the fistula, causing reduced blood flow to your extremity. The prevalence of steal syndrome ranges from 1% to 20% and it occurs secondary to the shunting of arterial blood flow through the AV access and away from the peripheral system 1.
Key Considerations
- Steal syndrome can progress to skin ulceration or gangrene necessitating a digit or limb amputation if not promptly addressed 1.
- The presence of an arterial inflow stenosis, such as subclavian artery stenosis, as well as an outflow stenosis, may exacerbate the condition 1.
- Diagnostic arteriography of the extremity and the entirety of its inflow is a foundational part of the diagnostic evaluation prior to determining management 1.
Recommended Course of Action
- While waiting for medical attention, keep your arm elevated and avoid tight clothing or accessories that could further restrict blood flow.
- Your doctor may need to perform a physical examination and vascular studies, such as fistulography or digital subtraction angiography (DSA), to assess blood flow and identify any hemodynamically significant stenoses 1.
- Treatment options range from conservative management (observation and symptom management) to surgical interventions like fistula banding or revision, depending on severity 1.
Important Notes
- Never attempt to compress or manipulate the fistula yourself as this could cause clotting or other complications.
- Prompt attention is crucial as prolonged ischemia can lead to tissue damage or even necrosis in severe cases 1.
From the Research
Symptoms and Possible Causes
- Weakness, pain, and cold skin in the forearm and hand after fistula placement may be related to steal syndrome, a known complication of arteriovenous fistulas and grafts 2, 3.
- Steal syndrome occurs when blood flow is diverted away from the affected limb, leading to ischemia and potentially severe symptoms 2.
- Factors associated with steal syndrome include atherosclerotic burden, access configuration, and the use of brachial artery inflow 2.
Diagnosis and Treatment
- Diagnosis of steal syndrome typically involves a combination of patient history, physical examination, and imaging studies such as color duplex ultrasound and angiography 3.
- Treatment options for steal syndrome vary depending on the severity of symptoms and access flow volume, and may include access revision or sacrifice, distal revascularization, and interval ligation 2, 3.
- Patient characteristics such as age, sex, and medical history may also influence the development and treatment of steal syndrome 2.
Related Conditions
- Steal syndrome can also affect the central nervous system, leading to neurological deficits and potentially severe consequences 4.
- Other conditions, such as acute lower limb ischemia, may also present with similar symptoms and require prompt evaluation and treatment 5.
- Coronary subclavian steal syndrome is a related condition that can occur in patients with internal mammary artery bypass grafts, and requires early detection and intervention 6.