Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Oct 28:11:2050313X231207710.
doi: 10.1177/2050313X231207710. eCollection 2023.

Rapid progression of finger gangrene in a hemodialysis patient: A case report

Maksim V Gusev  1 , Kristyn A Mannoia  1 , Sheela T Patel  1
Affiliations
Case Reports

Rapid progression of finger gangrene in a hemodialysis patient: A case report

Maksim V Gusev et al. SAGE Open Med Case Rep. .

Abstract

Severe hemodialysis access-induced distal ischemia is an uncommon complication after arteriovenous fistula creation. Finger amputation is rare and generally does not involve the entirety of the digit. The distal revascularization interval ligation procedure has become less commonly used for hemodialysis access-induced distal ischemia over the past decade. The procedure typically requires general anesthesia, greater saphenous vein harvest, and brachial artery ligation. We describe a 64-year-old female with hypertension, diabetes mellitus, and end-stage renal disease on hemodialysis via a well-functioning brachiocephalic arteriovenous fistula who developed rapid progression of finger gangrene. She underwent the distal revascularization interval ligation procedure, followed by finger amputations. The finger amputations healed within 6 months of the distal revascularization interval ligation procedure and the fistula was preserved at 2-year follow-up.

Keywords: Hemodialysis; gangrene; steal syndrome.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) and (b): Dorsal and palmar aspects of the left hand with gangrenous changes of the third and fifth fingers. (c) and (d) Progression of third finger gangrene 1 week later. (e) Left upper extremity angiogram demonstrating patent brachiocephalic anastomosis (f) and lack of opacification of the brachial artery beyond the arteriovenous anastomosis. (g) and (h) Filling of the brachial and radial arteries with manual compression of the fistula. Note that the ulnar artery is diminutive.
Figure 2.
Figure 2.
(a) Intraoperative photograph of the left upper extremity DRIL procedure. (b) Completion angiogram demonstrating patent brachiocephalic arteriovenous fistula and patent brachial artery to brachial artery vein bypass graft. (c) and (d) Dorsal and palmar aspects of the left hand 6 months following the DRIL procedure. (e) Right thigh greater saphenous vein harvest site 6 months following the DRIL procedure.
Figure 3.
Figure 3.
Treatment options for hemodialysis-access-induced distal ischemia.
See this image and copyright information in PMC

References

    1. Scali ST, Huber TS. Treatment strategies for access-related hand ischemia. Semin Vasc Surg 2011; 24: 128–136. - PubMed
    1. Huber TS, Larive B, Imrey PB, et al.. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg 2016; 64: 1050–1058. - PMC - PubMed
    1. Knox RC, Berman SS, Hughes JD, et al.. Distal revascularization-interval ligation: a durable and effective treatment for ischemic steal syndrome after hemodialysis access. J Vasc Surg 2002; 36: 250–255. - PubMed
    1. Kordzadeh A, Parsa AD. A systematic review of distal revascularization and interval ligation for the treatment of vascular access-induced ischemia. J Vasc Surg 2019; 70: 1364–1373. - PubMed
    1. Schanzer H, Schwartz M, Harrington E, et al.. Treatment of ischemia due to “steal” by arteriovenous fistula with distal artery ligation and revascularization. J Vasc Surg 1988; 7: 770–773. - PubMed

Publication types

LinkOut - more resources