J Korean Soc Transplant.  2013 Dec;27(4):190-193. 10.4285/jkstn.2013.27.4.190.

A Case of Ischemic Steal Syndrome in a Renal Transplantation Recipient

Affiliations
  • 1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. sjpjoon@hanyang.ac.kr
  • 2Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea.

Abstract

Ischemic steal syndrome (ISS) is one of the serious complications that can occur after construction of an arteriovenous fistula (AVF) for hemodialysis (HD). Because AVF-related ISS symptoms are usually aggravated during HD sessions, a few cases of ISS in kidney transplantation (KT) recipients have been reported in the literature. We describe a 63-year-old male with diabetic nephropathy who created AVF for maintenance HD and presented with pain at rest and tissue necrosis of the left distal fingers at 10 years post-KT. Brachial angiography revealed the presence of attenuated blood flow through the distal ulnar artery. He underwent finger amputation and AVF ligation, leading to complete relief of ischemic symptoms. The aim of this case report is to help clinicians to diagnosis a steal syndrome in kidney transplantation with a careless AVF for a long period of time.

Keyword

Kidney transplantation; Steal syndrome; Arteriovenous fistula

MeSH Terms

Amputation
Angiography
Arteriovenous Fistula
Diabetic Nephropathies
Diagnosis
Fingers
Humans
Kidney Transplantation*
Ligation
Male
Middle Aged
Necrosis
Renal Dialysis
Ulnar Artery

Figure

  • Fig. 1. Dry gangrene (arrows) of the second, third, and fourth digits of the left hand before fistula ligation. At the site of fore-arm, patent arteriovenous fistula (arrowheads) is seen. (A) Dorsal and (B) palmar aspects of left hand.

  • Fig. 2. Brachial angiography showing (A) diversion of blood to the arteriovenous fistula with attenuated distal vessels, occlu-sion of distal ulnar artery (arrow). And, diminished blood flow to digital hand. (B) Follow-up the angiography showing normal blood flow to digital hand when compression of vein involved in a fistula.


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