Multiple Finger and Hand Necroses Caused by Hemodialysis-associated Steal Syndrome

DOI Web Site 1 References
  • MURATA Maho
    Department of Dermatology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
  • SONOYAMA Hiroko
    Department of Dermatology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
  • MASHINO Toshihiko
    Department of Dermatology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
  • GUNTANI Atushi
    Department of Vascular Surgery, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
  • FURUE Masutaka
    Department of Dermatology, Graduate School of Medical Sciences, Kyusyu University

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Other Title
  • 盗血現象を認めた透析患者の手指壊死
  • 症例 盗血現象を認めた透析患者の手指壊死
  • ショウレイ トウケツ ゲンショウ オ ミトメタ トウセキ カンジャ ノ テサシ エシ

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Description

A 54-year-old Japanese man with diabetes mellitus and chronic renal failure developed multiple finger and hand necroses. He had received hemodialysis for 13 years. Six months before the appearance of his current symptoms, an arteriovenous shunt on his left forearm became occluded by local bacterial infection. A new arteriovenous shunt was created on the right forearm. However, blood flow to the right hand gradually decreased even though percutaneous transluminal angioplasty was performed several times to prevent shunt stenosis. Multiple finger and hand necroses occurred and spread after a slight injury. An angiogram showed increased blood flow after pressing the arteriovenous shunt, which indicated a diagnosis of blood steal syndrome. Brachial-radial artery bypass successfully overcame his ischemic problem, and the necrotic ulcers rapidly healed after debridement and negative pressure wound therapy. Skin lesions of dialysis patients are difficult to diagnose and treat, and it is necessary to observe them carefully.

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