Case reportBilateral dialysis-associated steal syndrome
Section snippets
Case report
A 74-year-old male with a history significant for ESRD receiving hemodialysis via a left arm AVF for 1 year, liver transplant, hypertension, and insulin-requiring diabetes presented to our clinic for evaluation of a painful lesion on his left fourth finger and left second finger. He had previously been treated with both oral and intravenous antibiotics while on hemodialysis without improvement. He described the pain as excruciating and denied trauma, fevers, or chills.
The physical examination
Discussion
DASS is a potentially catastrophic complication of AVF creation that often leads to gangrene and possibly amputation. As the number of patients on hemodialysis increases in the United States, the number of patients at risk for DASS will continue to rise. Prompt recognition is necessary in order to lower the risk of tissue loss. Diagnosis is made via a fistulogram with and without manual compression. In DASS, there is minimal blood flow distal to the AVF that improves when the AVF is compressed.
References (12)
- et al.
Minimally invasive limited ligation endoluminal-assisted revision (MILLER) for treatment of dialysis access-associated steal syndrome
Kidney Int
(2006) - et al.
Strategies for predicting and treating access induced ischemic steal syndrome
Eur J Vasc Endovasc Surg
(2006) - et al.
Incidence and characteristics of patients with hand ischemia after a hemodialysis access procedure
J Surg Res
(1998) - et al.
Ischemic steal syndrome: A case series and review of current management
Curr Surg
(2006) - et al.
Arterial steal syndrome: A modest proposal for an old paradigm
Am J Kidney Dis
(2006) - et al.
Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis
J Vasc Surg
(2002)
Cited by (5)
Chronic Ulceration in a Kidney Transplant Recipient
2017, Actas Dermo-SifiliograficasJAAD Grand Rounds quiz: Hand ischemia in a hemodialysis patient
2014, Journal of the American Academy of DermatologyScreening for gastrointestinal, hepatic/biliary, and renal/urologic disease
2010, Journal of Hand TherapyCitation Excerpt :Symptoms can occur within hours of initial dialysis access but can be delayed by months.25 The therapist should report any of the following signs and symptoms to the physician: 26 Skin pallor (ischemia), skin lesions
The vasculopathic reaction pattern
2009, Weedon's Skin Pathology: Third EditionHemodialysis-associated steal syndrome: Case report
2010, Turkiye Klinikleri Dermatoloji
Funding sources: None.
Conflicts of interest: None declared.