# Postoperative changes of wrist-brachial index following arteriovenous fistula implantation correlate with steal syndrome, a prospective study

## TL;DR

This study shows that changes in wrist-brachial index after AVF surgery can predict steal syndrome, including severe cases requiring treatment.

## Contribution

The study demonstrates that immediate postoperative wrist-brachial index changes are a reliable predictor of steal syndrome after AVF implantation.

## Key findings

- Immediate postoperative WBI changes significantly predict steal syndrome (P = .02) and severe cases (P = .03).
- WBI changes correlated with hypertension and smoking but not other factors like age or diabetes.
- 23 patients had temporary steal syndrome, 16 had prolonged symptoms, and 3 required vascular reconstruction.

## Abstract

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in end-stage renal disease. Steal syndrome, a complication causing limb ischemia, may follow AVF implantation. This study evaluated whether postoperative wrist-brachial index (WBI) changes predict steal syndrome, including severe cases requiring intervention. In a prospective study, patients undergoing first-time AVF implantation in 2022 were enrolled. WBI was measured preoperatively, immediately postoperatively, at 2 weeks, and at 3 months. Steal syndrome symptoms (pain, pallor, coldness, numbness, and paresthesia) were assessed at follow-ups. Data were analyzed using the Shapiro-Wilk, t test, and Mann-Whitney U tests (P < .05). Of 59 patients (31 men, 28 women; mean age, 56.9 ± 12.6 years), 23 (39%) had temporary steal syndrome, 16 (27.1%) had prolonged steal syndrome, and 3 (5.1%) required vascular reconstruction for severe ischemia. Immediate postoperative WBI changes (mean of 64.05% in severe cases vs 22.10% overall) were significantly associated with steal syndrome (P = .02), including severe cases (P = .03). Associations at 2 weeks (P = .14) and 3 months (P = .11) were not significant. WBI changes correlated with hypertension and smoking but not age, sex, dialysis duration, diabetes, or body mass index. Immediate postoperative WBI changes reliably predict steal syndrome, including severe cases, after AVF implantation. Close monitoring is essential for patients with significant WBI reductions.