title: Hand Ischemia in a Patient With an Arteriovenous Fistula.
abstract: An ischemic digit causes significant morbidity due to its associated discomfort and potential for tissue necrosis. Historically, when this phenomenon was peripheral to an ipsilateral arteriovenous access in a hemodialysis patient, it was called "steal syndrome" and was usually treated with access ligation, resulting in loss of the access. We present a dialysis patient with hand pain due to ischemia that was referred for access ligation. Instead, a minimally invasive banding procedure was performed that resulted in access salvage and resolution of symptoms. We present images and a discussion of the diagnosis and treatment of distal hypoperfusion ischemia syndrome in this Imaging Teaching Case.
authors.affiliation: Interventional Nephrology, Division of Nephrology, University of Wisconsin, Madison, WI. Electronic address: asy@medicine.wisc.edu.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
authors.affiliation: Interventional Nephrology, Division of Nephrology, University of Wisconsin, Madison, WI.
authors.forename: Micah R
authors.initials: MR
authors.lastname: Chan
authors.affiliation: Interventional Nephrology, Division of Nephrology, Albany Medical Center, Albany, NY.
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008026:Ligation / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017534:Radial Artery / Q000000981:diagnostic imaging; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods; D012086:Reoperation / Q000379:methods*; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000000981:diagnostic imaging
keywords: Hand ischemia; arterial steal; arterial stenosis; arteriovenous fistula; interventional nephrology