Access-associated steal syndrome (AASS) is a potentially limb-threatening complication of hemodialysis vascular access caused by preferential diversion of arterial inflow into the access circuit, resulting in distal hypoperfusion.Clinical severity ranges from exertional ischemia to rest pain and tissue loss and is more common in arteriovenous grafts than fistulas, particularly in patients with diabetes, peripheral arterial disease, advanced age, and proximal access.Diagnosis is primarily clinical and supported by noninvasive hemodynamic testing and duplex ultrasound.Management is guided by symptom severity, with revascularization or flow-reduction procedures achieving symptom relief in most patients while preserving access.
Kim et al. (Mon,) studied this question.