Vascular surgery: dialysis access steal: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Vascular surgery: dialysis access steal

Sample item

A diabetic man 3 weeks after a brachiocephalic arteriovenous fistula for dialysis develops a cold, painful, pale hand with rest pain in the fingers, though the fistula thrills well. What is the mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Diversion of arterial flow through the low-resistance fistula (steal syndrome)

Access-related hand ischaemia (steal) occurs when the low-resistance fistula draws blood away from the distal arterial bed, especially in diabetics with peripheral disease and with brachial artery based fistulae. Severe cases need ligation or distal revascularisation interval ligation. Venous hypertension produces a swollen, congested hand instead.

Option by option

  • A. Diversion of arterial flow through the low-resistance fistula (steal syndrome) (correct)

    Correct. Retrograde or diverted distal flow produces distal ischaemia.

  • B. Aneurysmal expansion of the vein

    Aneurysm causes a pulsatile mass with risk of rupture, not ischaemia.

  • C. Venous hypertension from outflow stenosis

    Venous hypertension causes swelling and congestion, not pallor and a cold hand.

  • D. Infection of the graft

    Infection presents with local inflammation and fever.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Diversion of arterial flow through the low-resistance fistula (steal syndrome). Access-related hand ischaemia (steal) occurs when the low-resistance fistula draws blood away from the distal arterial bed, especially in diabetics with peripheral disease and with brachial artery based fistulae.

Why is "Aneurysmal expansion of the vein" not the answer?

Aneurysm causes a pulsatile mass with risk of rupture, not ischaemia.

Why is "Venous hypertension from outflow stenosis" not the answer?

Venous hypertension causes swelling and congestion, not pallor and a cold hand.

Why is "Infection of the graft" not the answer?

Infection presents with local inflammation and fever.

What concept does this question test?

It tests Vascular surgery: dialysis access steal in General Surgery. Severe cases need ligation or distal revascularisation interval ligation. Venous hypertension produces a swollen, congested hand instead.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vascular surgery: dialysis access steal?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.