Distal Hypoperfusion Ischemic Syndrome in a Patient With End-Stage Renal Disease

Abstract

Distal hypoperfusion ischemic syndrome (DHIS), also known as dialysis access steal syndrome (DASS), is a rare but significant complication in patients with end-stage renal disease (ESRD) undergoing hemodialysis through arteriovenous fistulas (AVFs). This case report presents a female patient in her 40s with a complex medical history, including peripheral arterial disease, coronary artery disease, and recurrent cellulitis affecting her right hand, who developed DHIS following the placement of a brachiobasilic AVF. Despite optimal medical management, the patient exhibited persistent ischemic symptoms, including hand coolness and necrosis, ultimately requiring surgical ligation of the AVF. Postoperatively, her symptoms significantly improved, highlighting the importance of early recognition and intervention in managing DHIS. This case demonstrates the need for a multidisciplinary approach involving nephrologists, vascular surgeons, and primary care providers to optimize patient outcomes and prevent severe complications. Furthermore, it emphasizes the necessity for standardized screening protocols for high-risk patients with AVFs, considering the psychosocial factors that can impact treatment adherence and long-term management.

Keywords: chronic renal failure; dialysis; renal intervention; renal medicine; vascular surgery.

Figure 1. Calcification of peripheral vessels is evident on the hand X-ray lateral view (shown by arrows).

Figure 2. Calcification of peripheral vessels is evident on the hand X-ray superior view (shown by arrows).