Presentation
During the hemodialysis session, the patient complained of paresthesia and a sensation of cold extremities in the left hand, on the same side as the arteriovenous fistula (AVF). Peripheral pulses were present, and the arteriovenous fistula was functioning.
Patient Data
In the sequence of images, we can see the pre-AVF radial artery, which shows an increased caliber and the AVF in a sagittal view.
The evaluation of the velocity of the pre-AVF radial artery shows a peak systolic velocity close to 300 m/s, within the expected range for normality.
Radial artery lateral-to-lateral AVF with the cephalic vein. There are no signs of thrombosis.
Evaluation of the distal radial artery (post-AVF) with spectral Doppler showing bidirectional flow, both anterograde and retrograde.
Doppler study of the ulnar artery showing no abnormalities.
Case Discussion
Rarely, a patient may experience symptoms of arterial steal with an arteriovenous fistula (AVF), such as hand pain and paresthesia, particularly during dialysis. The direction of flow in the distal radial artery is assessed using color and spectral Doppler. Arterial steal is diagnosed when flow in the radial artery is reversed. It is important to recognize that asymptomatic arterial steal may be present in AVFs and may have no clinical significance ¹.
As a differential diagnosis for this type of clinical presentation, we can mention hematoma, peripheral nerve compression, thrombosis in the fistula, and carpal tunnel syndrome.
Special thanks to Dr Giovanni B. P. Lima, radiologist and staff physician at HC-UFTM.
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