Arterial Pressure Gradient of Upper Extremity Arteriovenous Access Steal Syndrome: Treatment Implications

Thomas Reifsnyder, George J. Arnaoutakis

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: Treatment options after arteriovenous fistula (AVF) associated steal include ligation, banding, and distal revascularization-interval ligation (DRIL). The purpose of this study was to evaluate the arterial pressure gradients in upper extremity steal syndrome. Methods: Preoperative arteriography and sequential intra-arterial pressure readings were performed on consecutive AVF patients with hand ischemia. Analysis of variance (ANOVA) with repeated measures analyzed intersubject comparisons, and post hoc analysis identified anatomic locations with highest inflow pressures. Results: Nine patients presented with ischemic hand symptoms after AVF. Pullback arterial pressure measurements revealed gradual increases in systolic and mean pressures as the catheter position was moved proximally from the AVF anastomosis. Post hoc analysis after ANOVA revealed higher axillary artery systolic pressure compared to proximal brachial artery (153 vs 116.8, P = .007). Conclusion: AVF-related steal syndrome decreases arterial inflow pressure of the affected extremity more proximally than previously thought. When performing a DRIL procedure, consideration should be given to placing the anastomosis as proximally as possible.

Original languageEnglish (US)
Pages (from-to)650-653
Number of pages4
JournalVascular and endovascular surgery
Issue number8
StatePublished - Nov 2010


  • arteriovenous access
  • hemodynamic
  • measurements
  • steal syndrome

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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