A case of refractory dialysis access-associated steal syndrome successfully treated by additional stellate ganglion block

Abstract

We report a patient who underwent stellate ganglion block (SGB) for refractory dialysis access-associated steal syndrome (DASS). A 50s-year-old man who had an internal shunt placed in his left forearm 10 years ago due to chronic kidney failure. Two months ago, he noticed a color change in his left hand fingers that worsened during dialysis, as well as cold and painful sensations. He was diagnosed with DASS, and vasodilators and analgesics were prescribed for these symptoms, and arteriovenous fistula removal was performed, but they did not provide relief. Then, we changed analgesics and performed SGB, which resulted in symptom relief at the first attempt. DASS is caused by a peripheral circulatory disturbance due to steal phenomenon in radiocephalic arteriovenous fistula. Therefore, the effect of additional SGB on blood flow may be efficacious in treating ischemic symptoms in refractory DASS.