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Critical Situations
October 2002

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

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.

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