Angioplasty of Forearm Arteries: A New Approach to Manage Dialysis-Associated Steal Syndrome

Background: The steal syndrome is an ischemia of the hand, secondary to a decrease of its peripheral perfusion, due to the confection of a vascular access for hemodialysis, usually an arterio-venous fistula of the upper limbs. This syndrome is due to a local hemodynamic change and to the diversion of the distal arterial blood to the venous system. Its origin might be either hemodynamic, arterial or venous. The affection of the distal fore-arm arteries might be an etiology, yet neglected. This rare affection is rare but potentially disabling might be revealed by pain following an effort or even at rest and it might also be revealed by an ulcer, necrosis or gangrene. In the litterature and also in the daily practise, the treatment of this syndrome is usually a surgical treatment and it consists in decreasing the blood flow through the arteriovenous shunt or in enhancing the distal perfusion circumventing the arteriovenous fistula. There is only few data in the litterature concerning the endovascular treatment of arterial lesions of the fore-arm symptomatic of steal syndrome with arteriovenous fistula in patients suffering of chronic renal failure. The aim of our study is to evaluate the feasibility, the security and the results of the angioplasty of fore-arm arteries in the management of dialysis -associated steal syndrome. Method(s): We herein describe four cases of male patients with terminal chronic renal failure at the stage of hemodialysis via an arteriovenous fistula of the upper limbs. All patients were symptomatic of steal syndrome. Dupplex ultrasound and CT angiography were the examinations for the diagnosis of arteritis of the forearm. Result(s): All the patients underwent endovascular therapy. We proceeded with an angioplasty of the different lesions of the forearm arteries. The immediate postoperative course was marked by the presence of distal pulses and less ischemic pain. Long term out come was marked by healing of the amputation site,pain disappearing and functional arteriovenous fistula. Conclusion(s): The treatment methods that the vascular surgeon has are various and the endovascular treatment seems to become the treatment of choice. This procedure is simple, secure with an interesting good rate of limb salvage. It allows to treat the ischemia, preserve the vascular access and avoid the surgical intervention in patients with heavy medical history.