Multiple finger and hand necroses caused by hemodialysis-associated steal syndrome

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.