SHM Converge Scientific Abstract ePoster Gallery-The Circulation Thief: A Case of Dialysis-Associated Steal Syndrome (Dass) Presenting as a Painful Non-Healing Ulcer

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This poster describes dialysis access-associated steal syndrome (DASS), a rare complication of hemodialysis access creation, occurring in fewer than 2% of brachial AV fistula cases. In DASS, a low-resistance arteriovenous fistula diverts blood away from the distal limb, causing reduced perfusion and ischemic injury.<br /><br />The case involves a 57-year-old woman with end-stage renal disease on hemodialysis and a history of abdominal wall calciphylaxis who developed a painful, non-healing wound on her right hand after two months without trauma. The lesion did not improve with supportive care or oral antibiotics. On exam, she had a dry papulonodular lesion with a central keratin plug on the right fourth finger and severe pain limiting finger movement. Initial work-up, including MRI, ruled out osteomyelitis and necrotizing infection. Biopsy was negative for calciphylaxis but showed ischemic changes. Duplex ultrasound of the AV fistula confirmed DASS.<br /><br />The poster highlights that chronic DASS may present with pain, pallor, cool extremities, ulcers, nail changes, or tissue atrophy, while acute DASS can resemble limb ischemia. Symptoms often worsen during dialysis. Diagnosis is largely clinical and supported by vascular testing such as duplex Doppler ultrasound with manual fistula compression, digital pressures, brachial artery digit index, and angiography.<br /><br />Management is surgical and aims to restore distal blood flow, using approaches such as banding, angioplasty, or fistula revision. The differential diagnosis for skin ulcers in patients with renal disease is broad and includes calciphylaxis, necrobiosis lipoidica, vasculitis, vascular/embolic disease, pressure ulcers, infection, drug reactions, and insect bites.

Asset Subtitle

Christopher Babu

Meta Tag

Author List Christopher Babu, Samantha Wang

Category Clinical Vignettes

Concept Dialysis-Associated Steal Syndrome

Concept Distal Ischemia

Concept Distal Perfusion

Concept Lower Extremity Vascular Ultrasound

Concept Calciphylaxis

Distinguished Non-Finalist

Presenter Organization Stanford Medicine

Presenting Author Christopher Babu

Track Adult

Keywords

dialysis access-associated steal syndrome

DASS

hemodialysis access

brachial AV fistula

distal limb ischemia

duplex ultrasound

end-stage renal disease

painful hand ulcer

calciphylaxis differential

vascular surgery

Dialysis-Associated Steal Syndrome

Distal Ischemia

Distal Perfusion

Lower Extremity Vascular Ultrasound

Calciphylaxis