Authored by Supraja Thunuguntla*
Abstract
Dialysis Access Associated Steal Syndrome (DASS) reported incidence is low, (6.2%) [1]. Symptoms are dialysis induced hand pain, coldness, numbness, sensory loss which can lead to inevitable digital gangrene and amputation if the diagnosis is delayed. Duplex arterial ultrasound and electromyography (EMG) can help differentiate DASS from Ischemic monomelic neuropathy (IMN), a variation of DASS. Treatment options are individualized based on the location of the AV fistula, severity of presentation, presence of anatomical anomalies of involved vasculature. Comprehensive review of literature demonstrates this outcome of finger gangrene in young patients with ESRD is primarily associated with preexisting diffuse vascular disease [2].
Keywords: Dialysis Access Steal Syndrome; Ischemic monomelic neuropathy; Limb Ischemia; AV access
Keywords: DASS: Dialysis Access Steal Syndrome; EMG: Electromyography; IMN: Ischemic Monomeric Neuropathy; AV: Arteriovenous; ESRD: End-stage Renal Disease; ER: Emergency Room; PAI: Proximalization of Arterial Inflow
Introduction
Patients needing Hemodialysis require a lifelong sustained strategy for creation and maintenance of their hemodialysis access (AV Access) to minimize complications and preserve functionality. We report a 36-year-oldman who presented with dry gangrene of his fingers after uneventfully receiving Hemodialysis for over a year.
Case Presentation
A 36-year-old man with a history of diabetes mellitus type 1, hypertension, peripheral vascular disease, ESRD on hemodialysis, non-communicative after multiple cerebrovascular accidents who was brought to the Emergency. Room (ER) by his caregiver and sister who had noticed blackening of the fingers of left hand for over a month. Patient is disabled, lives at a nursing & rehabilitation center. There was extensive discoloration of the left ring finger and tip of the index finger evident on physical exam with corresponding loss of sensation. The affected area appeared black, hardened and dry to palpation and presented a clean line of demarcation compatible with the clinical diagnosis of dry gangrene [1,2] (Figure 1&2). Radial pulse was weak to palpation. His AV access was located on the same side as the affected (Finger 3).
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