Hemodialysis access-related arterial steal syndrome can result in serious complications, such as tissue loss and amputation. Several methods have been used to treat arterial steal syndrome, but controversy persists regarding the optimal technique. Here we present a case of arterial steal syndrome successfully treated with proximalization of arterial inflow (PAI). A 63-year-old man with a brachial-cephalic arteriovenous fistula (AVF) was admitted with complaints of coldness and pain in the left

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... and and fingers. Duplex sonography and angiography revealed arterial steal and occlusion of the distal radial artery. He was underwent PAI which included transsection of the AVF just distal to the previous anastomosis and attachment of the arterialized vein to a more proximal portion of the brachial artery with a 4-mm expanded polytetrafluoroethylene graft. Digital arterial flow was restored, and his symptoms subsequently were relieved. The AVF was well-functioning without any ischemic symptoms after 3-month follow-up.