Case report
Bilateral dialysis-associated steal syndrome

https://doi.org/10.1016/j.jaad.2008.01.009Get rights and content

Dialysis-associated steal syndrome (DASS) is an uncommon complication of arteriovenous fistula formation, but can have dire consequences. This entity is likely to be seen more commonly in the future as the number of patients with end stage renal disease increases. We present the unique case of a patient with end stage renal disease who developed bilateral DASS after presenting with a painful skin lesion.

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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.

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    Citation 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

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  • Hemodialysis-associated steal syndrome: Case report

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Funding sources: None.

Conflicts of interest: None declared.

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