Question: I am on kidney dialysis and have "steal syndrome" in my lower arm and hand. It is very painful, drawn at times and cold. I've talked to all my doctors—neurosurgeon, vascular surgeon, urologist—and they have no suggestions.

Dr. Hibberd's Answer:

Dialysis requires a reliable arterial access. A connection (called a shunt or fistula) is formed by a vascular surgeon between an artery and vein to allow repeated dialysis catheter access. A steal syndrome may occur where this fistula is placed and may sometimes cause vascular insufficiency (or "stealing" of blood circulation) of the downstream circulation of the hand and fingers.

Treatment of steal syndrome is surgical, and is usually performed by a vascular surgeon. There are no medicines that will reliably improve steal syndrome. When severe, the arterial blood supply to the hand is basically forced into a backward flow where blood destined for the hand and fingers is drawn from the main artery across the palm and travels backwards up the radial artery to the fistula. If severe, this can be very painful or even hazardous to hand circulation. It is usually seen more often in atherosclerotic and diabetic patients.

Aside from re-location of the fistula, relief may often obtained by vascular remediative surgery of the arterial supply to the hand and wrist to reduce this reverse flow phenomenon. Otherwise, protect your hand from injury and cold.