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:
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 

Subscribe to view more

For full access to this article, log in to an existing user account, purchase an annual subscription, or purchase a short-term subscription.

Order a subscription


Pay Per View

Entire Journal
30-Day Access


Buy Now

This Issue
7-Day Access


Buy Now

This article
24-Hour Access


Buy Now

Sign In Or Create an account

Please sign in using your login.
If you do not have an AOA login, you may create a new account.

Or Subscribe