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Dialysis-associated steal syndrome occuring after creation of arteriovenous fistula for hemodialysis is an uncommon but disturbing and often debilitating complication of upper extremity arteriovenous fistulas. It is decidedly rare with radiocephalic fistulas and more common with proximal arm fistula. We describe a patient who developed a symptomatic steal with finger gangrene after brachiocephalic fistula creation. Flow reduction techniques were not successful and finally the ligation was needed to save the hand.