Abstract
Severe dialysis access associated steal syndrome (DASS) occurs in around 3-5% of case of arterio-venous fistulae (AVF). We report successful treatment of a severe DASS case with a brachio-radial artery bypass. A 56-year-old man presented with a non-healing ischemic ulcer at the amputated ends of the left fourth and fifth fingers as a result of DASS. The diabetic patient had an AVF between the left brachial artery and basilar vein, and a long history of AVF related troubles. Arteriography revealed multiple severe stenoses in the ulnar artery, and a long occlusion of the proximal radial artery. The palm was mainly blood-fed by the distal radial artery, which was opacified by the collateral vessels. The proximal anastomosis on the brachial artery was located 5 cm upstream from the AVF, while the distal anastomosis was on the radial artery 2 cm proximal from the wrist joint. The operation increased the radial artery blood flow, mitigated the ischemia, and led to successful limb salvage.
