2020 Volume 31 Issue 1 Pages 29-33
Interventions for the dialysis access-associated steal syndrome (DASS) are difficult because peripheral arterial flow has to be increased without losing vascular access function. We report a case with limited puncture sites and the DASS, treated successfully with basilic vein transposition (BVT) and proximalization of the arterial inflow (PAI). A 49-year-old woman with a 5-year history of hemodialysis due to diabetic kidney disease had suffered from the symptom of numbness of her left fingers during hemodialysis for two years. This symptom subsequently progressed to rest pain. The access sites for hemodialysis were limited to about a 5 cm length of the median basilic vein in the cubital region. Pulsation of the radial and ulnar arteries was not palpable, while left wrist blood pressure/contralateral brachial blood pressure was 50/130 mmHg. BVT for limited access sites and PAI using a 5 mm diameter prosthetic graft for DASS were performed. Soon after these surgical interventions, the symptoms disappeared and a sufficient length of autogenous vein puncture sites was obtained.
