A Case of Ischemic Steal Syndrome in a Renal Transplantation Recipient

In Sub Jung; Jong Min Choi; Hye Jin Yoon; Yoomi Yeo; Sang Ki Lee; Ji Young Yhi; Jeong Eun Kim; Il Hwan Oh; Hee Chang Ahn; Chong Myung Kang; Joon-Sung Park

doi:10.4285/jkstn.2013.27.4.190

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Jung, Choi, Yoon, Yeo, Lee, Yhi, Kim, Oh, Ahn, Kang, and Park: A Case of Ischemic Steal Syndrome in a Renal Transplantation Recipient

Case Report

J Korean Soc Transplant 2013;27(4):190-193.

Published online: 11 January 2013

DOI: https://doi.org/10.4285/jkstn.2013.27.4.190

A Case of Ischemic Steal Syndrome in a Renal Transplantation Recipient

In Sub Jung, M.D.¹, Jong Min Choi, M.D.¹, Hye Jin Yoon, M.D.¹, Yoomi Yeo, M.D.¹, Sang Ki Lee, M.D.¹, Ji Young Yhi, M.D.¹, Jeong Eun Kim, M.D.¹, Il Hwan Oh, M.D.¹, Hee Chang Ahn, M.D.², Chong Myung Kang, M.D.¹, Joon-Sung Park, M.D.¹

¹Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

²Departments of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea

책임저자：박준성, 서울시 성동구 왕십리로 222 한양대학교병원 신장내과, 133-791 Tel: 02-2290-8317, Fax: 02-2298-9183 E-mail: sjpjoon@hanyang.ac.kr 133-791 Tel: 02-2290-8317, Fax: 02-2298-9183 E-mail: sjpjoon@hanyang.ac.kr

Received 21 August 201330 September 2013 Accepted 17 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Ischemic steal syndrome (ISS) is one of the serious complications that can occur after construction of an arteriovenous fistula (AVF) for hemodialysis (HD). Because AVF-related ISS symptoms are usually aggravated during HD sessions, a few cases of ISS in kidney transplantation (KT) recipients have been reported in the literature. We describe a 63-year-old male with diabetic nephropathy who created AVF for maintenance HD and presented with pain at rest and tissue necrosis of the left distal fingers at 10 years post-KT. Brachial angiography revealed the presence of attenuated blood flow through the distal ulnar artery. He underwent finger amputation and AVF ligation, leading to complete relief of ischemic symptoms. The aim of this case report is to help clinicians to diagnosis a steal syndrome in kidney transplantation with a careless AVF for a long period of time.

Keywords: Kidney transplantation, Steal syndrome, Arteriovenous fistula

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Fig. 1.

Dry gangrene (arrows) of the second, third, and fourth digits of the left hand before fistula ligation. At the site of fore-arm, patent arteriovenous fistula (arrowheads) is seen. (A) Dorsal and (B) palmar aspects of left hand.

Fig. 2.

Brachial angiography showing (A) diversion of blood to the arteriovenous fistula with attenuated distal vessels, occlu-sion of distal ulnar artery (arrow). And, diminished blood flow to digital hand. (B) Follow-up the angiography showing normal blood flow to digital hand when compression of vein involved in a fistula.

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