Resolution of Steal Syndrome due to Aneurysmal Degeneration of Brachiocephalic Arteriovenous Fistulas

Abstract

Introduction: Steal syndrome associated with arteriovenous access for hemodialysis is an uncommon but potentially serious ischemic complication, especially when associated with aneurysmal degeneration of the venous pathway, which may lead to hyperflow and worsen distal ischemia.

Objective: To present the first clinical cases of steal syndrome associated with aneurysmal degeneration of brachiocephalic AV fistulas, through resection of the aneurysmal segment and flow control using the banding technique with interposition of a polytetrafluoroethylene graft.

Methods: This case report was prepared in accordance with the CARE Guidelines to ensure a transparent, complete, and structured presentation of clinical information. The official checklist available on the EQUATOR network website was used.

Results: Surgical management included resection of the aneurysmal segments and flow restriction through controlled banding with interposition of a polytetrafluoroethylene graft. Both patients experienced complete resolution of ischemic symptoms and functional preservation of the vascular access during follow-up.

Conclusions: The combination of aneurysmal resection and controlled banding represents an effective surgical option for the treatment of steal syndrome in high-flow accesses, maintaining distal perfusion and preserving the usefulness of the access for hemodialysis.