Dialysis Access Steals and Leads to Limb Ischemia

Dialysis Access Associated Steal Syndrome (DASS) reported incidence is low, (6.2%) [1]. Symptoms are dialysis induced hand pain, coldness, numbness, sensory loss which can lead to inevitable digital gangrene and amputation if the diagnosis is delayed. Duplex arterial ultrasound and electromyography (EMG) can help differentiate DASS from Ischemic monomelic neuropathy (IMN), a variation of DASS. Treatment options are individualized based on the location of the AV fistula, severity of presentation, presence of anatomical anomalies of involved vasculature. Comprehensive review of literature demonstrates this outcome of finger gangrene in young patients with ESRD is primarily associated with pre-existing diffuse vascular disease [2].