Plication as Primary Treatment of Steal Syndrome in Arteriovenous Fistulas

Steal syndrome is an uncommon complication following hemodialysis access. Options for management include fistula ligation, banding, and distal revascularization with interval ligation (DRIL). Plication is another technique that is simple yet infrequently reported. We have adopted plication as the procedure of choice for steal syndrome following autologous arteriovenous fistula (AVF) creation. We report seven cases managed by plication. All had immediate resolution of symptoms (Table I). At follow-up, all AVFs were patent and continued to be used for hemodialysis. However, one patient experienced recurrence of symptoms and required re-plication. In conclusion, plication of the autologous AVF represents a simple alternative to the management of steal syndrome.