Intraoperative flow measurements are helpful in the treatment of high-inflow steal syndrome on a predialysis patient with a brachiocephalic fistula: a case report.

Distal revascularization and interval ligation (DRIL) is currently one of the mainstay treatments for severe steal syndrome. However, when high inflow is the underlying cause, this technique does not fully address the problem. Here, we describe the use of intraoperative flow measurements using transit time ultrasound technology to help identify the cause of steal syndrome in a predialysis patient (no transonic surveillance) with a brachiocephalic fistula, who then was treated successfully by inflow reduction surgery using a bovine ureter graft. We believe that inflow reduction might be superior to DRIL in treating steal syndrome caused by high inflow and that transit time ultrasound might be helpful when transonic treatment is not possible.