Dialysis Associated Steal Syndrome Evaluation that uses Photoplethysmography and Arterial Indices

Dialysis-associated steal syndrome (DASS) is an uncommon disease that can be detected with careful and precise sonographic techniques. Arteriovenous (AV) access surgery is performed for patients with end-stage renal disease (ESRD) requiring regular hemodialysis. DASS is defined as retrograde flow in the native artery, distal to the AV access anastomosis. The blood direction reverses and re-routes flow from the distal extremity into the proximal, surgically created AV access vein or graft. Without detection and treatment, tissue loss to the extremity can occur. A wrist brachial index (WBI) and digital brachial index (DBI) evaluation utilizing photoplethysmography (PPG) is useful to confirm suspected DASS and determine the stage or severity of the steal. Sonographers familiar with WBI will notice a change in protocol when evaluating a patient for steal syndrome. This advanced Doppler technique is demonstrated in the case of a patient with a brachiocephalic fistula and symptoms of DASS. A deeper understanding of steal syndrome and how to perform this uncommon examination could improve outcomes for patients with DASS.