Introduction: An arterio- Venous Fistula (AVF) is a connection between a vein and an artery, either intentional (man-made) or unintentional (formed by itself in the body thanks to trauma/pathology etc). A dialysis access AVF is created to provide a vessel for haemodialysis access in patients with end stage renal failure. An arterial steal is when we see reverse flow in the artery inferiorly to the anastomosis. Most AVFs that are more than 1 year old will have reversed flow inferior to the anastomosis and most will be asymptomatic. The ones we will focus on are the ones that become symptomatic.
Method: Patients were referred by renal physicians due to their symptoms, which included, cold hand/s with colour change to white or blue, pain during dialysis or during exercise, pain in the hand or arm while resting or in extreme cases, ulcers, necrotic tissue, gangrene. These patients were scanned using our protocol which I will go into more detail on in the presentation, with a focus on the measurements taken when assessing steal syndrome.
Results: 3 case studies showing the sonographic features of symptomatic steal syndrome including ulcerated fingers, colour change in the hands and ulcers.
Discussing measurements, where to take them and how to interpret them.
Conclusions: What to look for in when scanning these patients and how to interpret the sonographic features.
Take home message: Tips to make this scan easier and the key points.

This presentation introduces a focused, transabdominal duplex ultrasound approach to efficiently evaluate patients with suspected pelvic venous disorders.

Emphasis is placed on practical scanning techniques to assess the left renal vein for compression, ovarian veins for dilation and reflux, and the iliac veins for hemodynamically significant compression. Doppler waveform analysis, flow direction, velocity changes, and respiratory variation are used to distinguish normal physiologic findings from clinically relevant venous pathology.

By integrating anatomy with physiologic Doppler assessment, this targeted approach allows vascular sonographers to rapidly identify disease patterns, guide appropriate downstream imaging, and support procedural planning. This streamlined, protocol-driven strategy delivers clinically actionable information to the care team and improves diagnostic confidence in the evaluation of pelvic venous disorders.