Clinical Images  |   November 2018
Dry Digital Gangrene
Author Notes
  • From the Touro University College of Osteopathic Medicine–CA in Vallejo. 
  • Disclaimer: Dr Shubrook, an associate editor of The Journal of the American Osteopathic Association, was not involved in the editorial review or decision to publish this article. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Jay H. Shubrook, DO, 1310 Club Dr, Mare Island, Vallejo, CA 94592-1187. E-mail: jay.shubrook@tu.edu
     
Article Information
Cardiovascular Disorders / Imaging / Hypertension/Kidney Disease / Clinical Images
Clinical Images   |   November 2018
Dry Digital Gangrene
The Journal of the American Osteopathic Association, November 2018, Vol. 118, 765. doi:10.7556/jaoa.2018.166
The Journal of the American Osteopathic Association, November 2018, Vol. 118, 765. doi:10.7556/jaoa.2018.166
A 61-year-old man presented to a clinic with the complaint of 6 weeks of right middle finger pain and swelling. His medical history included type 2 diabetes mellitus, hypertension, peripheral arterial occlusive disease, and chronic kidney disease. The patient received dialysis through an arteriovenous fistula in his right arm. The right middle finger became gangrenous after 8 weeks (image A). Postpresentation arteriogram records indicated steal syndrome causing vascular insufficiency in all right hand digits (image B). The right middle finger autoamputated a few weeks later. 
Hemodialysis is a common risk factor for ischemia of the upper extremity, and amputation is a common sequelae.1 Studies have shown that currently the best management of dialysis-associated steal syndrome is distal revascularization with interval ligation, which involves ligating an artery distal to the fistula and subsequently forming a bypass.2 Owing to the high mortality rates of dialysis patients who require upper extremity amputations, early revascularization efforts are key.3 

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