Distal revascularization and interval ligation for femoral arteriovenous graft steal syndrome

Patients with end-stage renal disease and exhausted upper extremity options may require lower extremity arteriovenous grafts (AVGs) for hemodialysis access. We present a 62-year-old woman with a right superficial femoral artery-femoral vein looped AVG who developed limb-threatening ischemia secondary to steal syndrome. A distal revascularization and interval ligation procedure, using an external iliac-to-distal superficial femoral artery bypass with interval ligation, successfully restored perfusion while preserving access. The patient's ischemic symptoms resolved, and both AVG and bypass remained patent at >2 years, demonstrating distal revascularization and interval ligation as an effective limb-salvaging option.