Vascular insufficiency from AV fistula
Background
- Steal syndrome = Distal hypoperfusion ischemic syndrome
- 5-10% of brachial artery fistulas
- 1% of radial artery fistulas
- Classically elderly woman with DM
- Pt hx may include revascularization or banding efforts that restenose
Clinical Features
- Distal extremity becomes ischemic due shunting of arterial blood to venous side
- Exercise pain, nonhealing ulcers, cool, pulseless digits
Differential Diagnosis
AV Fistula Complications
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
Workup
- Diagnosed by Doppler US or angiography
Management
- Surgery
Disposition
- Admit