Hand Ischemia in a Patient With an Arteriovenous Fistula

An ischemic digit causes significant morbidity due to its associated discomfort and potential for tissue necrosis. Historically, when this phenomenon was peripheral to an ipsilateral arteriovenous access in a hemodialysis patient, it was called "steal syndrome" and was usually treated with access ligation, resulting in loss of the access. We present a dialysis patient with hand pain due to ischemia that was referred for access ligation. Instead, a minimally invasive banding procedure was performed that resulted in access salvage and resolution of symptoms. We present images and a discussion of the diagnosis and treatment of distal hypoperfusion ischemia syndrome in this Imaging Teaching Case.