Precision banding technique for arterial steal syndrome in a patient with chronic kidney disease on hemodialysis: A case report

Dialysis Access-Associated Steal Syndrome (DASS) is an uncommon but potentially limbthreatening complication of high-flow arteriovenous fistulas (AVFs) in hemodialysis patients.We report a 48-year-old woman with progressive ischemic symptoms of the left hand secondary to a high-flow brachiocephalic AVF.Doppler ultrasonography confirmed excessive access flow and severely reduced distal arterial perfusion.The patient underwent precision banding with continuous intraoperative Doppler guidance, allowing controlled flow reduction to a physiologic range and immediate restoration of distal perfusion.Symptoms resolved completely, and AVF patency was preserved at 1-year follow-up.