What is a potential complication of AV fistula with reduced distal arterial blood flow?

• A. Ischemia in fingers (cold, numb) or hand.
• B. Lymphedema of the arm only.
• C. Hyperkalemia without symptoms.
• D. Hyperglycemia.

Answer: (A)

The main idea here is the steal phenomenon from an arteriovenous fistula. When a fistula creates a low-resistance path between an artery and a vein, arterial blood can preferentially flow through the fistula rather than continuing to the distal arteries of the hand. If distal arterial flow becomes reduced, the tissues in the fingers or hand may become ischemic, leading to symptoms like coldness and numbness.

This makes ischemia in the fingers or hand the best answer, because it directly results from decreased perfusion to the hand caused by the fistula. Lymphedema, hyperkalemia, and hyperglycemia aren’t typically caused by reduced distal arterial blood flow from an AV fistula.