Investigating the presence of arterial steal syndrome in a patient: a case report

Access to the patient's circulation to perform hemodialysis can be temporary or permanent. However, arterial-to-venous vascular access is associated with the risk of dialysis-associated steal syndrome (DASS), which carries complications such as tissue or organ loss and increased mortality. This study aimed to present arterial steal syndrome suspicious in a patient.

A 49-year-old male patient had an arteriovenous fistula between the radial artery and cephalic vein in the distal right wrist. The patient had been experiencing cramps and pain in his hand during hemodialysis for about a month. At the time of referral, the patient had swelling, coldness, and numbness in his fingertips and was advised to undergo further diagnostic tests in the non-invasive diagnostic department of the hospital. The Doppler ultrasound showed a blood flow rate of 2205 milliliters per minute in the fistula, which was higher than normal. The finger pressure when pressure was applied to the fistula was higher than when no pressure was applied. The electromyography showed abnormal nerve conduction in the right median nerve. The right hand had no pathological muscle atrophy, weakness or numbness, and the muscle strength was good.

Finally, even though the diagnostic tests were done in favor of Steele's syndrome, but according to the opinion of the expert and the results of the electrodiagnosis tests, as well as considering that the patient's capillary oxygen saturation was within the normal range (96 to 99%), the final diagnosis of the patient's syndrome Carpal tunnel (CTS) was placed and the patient underwent surgery. After the surgery, the patient's symptoms such as cramps during hemodialysis, swelling, coldness and numbness in the fingertips have been resolved.