A 50-year-old man with a history of type 2 diabetes mellitus, coronary artery disease, peripheral vascular disease, and severe vascular calcification underwent placement of a brachial artery to antecubital vein arteriovenous fistula (AVF) in his left arm after the diagnosis of end-stage renal disease. He first experienced hand claudication and erythema of his left hand and digits 14 months after surgery. Pain and coldness of the left hand increased gradually over a 4-month period, and weakness was noted on examination. Vascular steal created by the fistula was suspected; however, the patient had a history of bilateral ulnar neuropathy, carpal tunnel syndrome, and generalized sensory axonal polyneuropathy. Ligation of the fistula was delayed because no other site was available for long-term angioaccess. The patient subsequently began continuous ambulatory peritoneal dialysis.
Pelle MT, Miller III OF. Dermatologic Manifestations and Management of Vascular Steal Syndrome in Hemodialysis Patients With Arteriovenous Fistulas. Arch Dermatol. 2002;138(10):1296-1298. doi:10.1001/archderm.138.10.1296