SHM Converge Scientific Abstract ePoster Gallery-The Robbed That Smiles, Steals Something From the Thief

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Dialysis steal syndrome is an increasingly important complication of arteriovenous fistulas used for hemodialysis. As the number of patients with chronic kidney disease and end-stage renal disease continues to rise, clinicians should recognize that dialysis steal syndrome may be underdiagnosed because symptoms vary widely. Manifestations range from mild coolness, pallor, paresthesia, and pain during dialysis to severe ischemia with rest pain, ulceration, tissue necrosis, and possible digit or hand amputation.<br /><br />Diagnosis begins with clinical suspicion, often supported by symptom improvement when the fistula is manually compressed. Noninvasive imaging is preferred to identify the anatomic cause. Physiologic studies such as digital pressures or waveforms with and without fistula compression are sensitive, while duplex ultrasound can show arterial stenosis or flow reversal.<br /><br />Treatment depends on symptom severity and ischemic stage. Mild cases may be managed conservatively by avoiding hypotension and using warming measures. More severe cases require intervention based on the underlying vascular lesion.<br /><br />The case presented involved a 65-year-old man with ESRD on hemodialysis, diabetes, and severe peripheral arterial disease. He was admitted for poor AV fistula flow and underwent fistulagram with angioplasty of venous stenoses, resulting in improved flow. Two days later, he developed left-hand pain and digital ulcers. Doppler ultrasound demonstrated a patent brachiobasilic AV fistula with high brachial artery velocities and distal antegrade flow, consistent with dialysis steal syndrome. Subsequent vasculogram showed steal phenomenon worsened by forearm and hand atherosclerosis, causing absent perfusion to the affected fingertips. Despite intervention, he ultimately required amputation of the involved digits.<br /><br />This case highlights the need for early recognition, appropriate imaging, and close follow-up to reduce morbidity from dialysis steal syndrome.

Asset Subtitle

Michael Dore

Meta Tag

Author List Aaron Hein, Brian Schneider, Michael Dore

Category Clinical Vignettes

Concept Dialysis-Associated Steal Syndrome

Concept Arteriovenous Fistula

Concept Ischemia

Concept Hemodialysis

Concept Necrosis

Distinguished Non-Finalist

Presenter Organization Durham Veterans Affairs Hospital

Presenting Author Michael Dore

Track Adult

Keywords

dialysis steal syndrome

arteriovenous fistula

hemodialysis

end-stage renal disease

ischemia

duplex ultrasound

vascular imaging

digital ulcers

peripheral arterial disease

amputation

Dialysis-Associated Steal Syndrome

Arteriovenous Fistula

Ischemia

Hemodialysis

Necrosis