517 Treatment of Steal Syndrome from a Brachioaxillary Haemodialysis Graft

Aim High flow steal syndrome is a rare complication of arteriovenous (AV) prosthetic grafts used for haemodialysis access. It can be classified as high flow (due to flow diversion away from the hand) or low flow (due to forearm arterial occlusion) The conventional method of treatment is ligation of the graft and use of a tunnelled line. However, dialysis via a graft reduces mortality and hospitalisation for sepsis and reduces central vein stenosis. The aim of this case was to establish the feasibility of flow restriction of a brachioaxillary graft that was causing high flow steal syndrome. Method A 70-year-old lady with a new left brachioaxillary graft developed early hand pain at rest (Tordoir 3 class ischaemic steal). Duplex demonstrated patent radial and ulnar arteries with flow reversal in the radial artery. There was high volume flow through the graft. Waveforms at the radial artery improved with external compression of the graft. A multi-disciplinary decision was made to attempt to salvage the graft rather than ligate it. Under local anaesthesia the GORE® ACUSEAL graft was exposed at the arterial anastomosis and 3 large metal Ligaclips were applied 1cm apart to flow restrict the AV graft. Results There was return of triphasic radial signal after the 3rd Ligaclip with preserved graft flow. 2 weeks following the procedure the patient resumed dialysis and had resolution of ischaemic rest pain. Conclusions Flow restriction through the application of Ligaclips is a new way of treating high flow steal syndrome in AV grafts.