World Journal of Pharmaceutical
and Medical Research

( An ISO 9001:2015 Certified International Journal )

An International Peer Reviewed Journal for Pharmaceutical and Medical Research and Technology
An Official Publication of Society for Advance Healthcare Research (Reg. No. : 01/01/01/31674/16)
ISSN (O) : 2455-3301
ISSN (P) : 3051-2557
IMPACT FACTOR: 6.842

ICV : 78.6

World Journal of Pharmaceutical and Medical Research (WJPMR) has indexed with various reputed international bodies like : Google Scholar , Index Copernicus , SOCOLAR, China , Indian Science Publications , Cosmos Impact Factor , Research Bible, Fuchu, Tokyo. JAPAN , Scientific Indexing Services (SIS) , UDLedge Science Citation Index , International Impact Factor Services , International Society for Research Activity (ISRA) Journal Impact Factor (JIF) , International Innovative Journal Impact Factor (IIJIF) , Scientific Journal Impact Factor (SJIF) , Global Impact Factor (In Process) , Digital Online Identifier-Database System (DOI-DS) , Science Library Index, Dubai, United Arab Emirates , Eurasian Scientific Journal Index (ESJI) , International Scientific Indexing, (ISI) UAE , IFSIJ Measure of Journal Quality , Web of Science Group (Under Process) , Directory of Research Journals Indexing , Scholar Article Journal Index (SAJI) , International Scientific Indexing ( ISI ) , Scope Database , Academia , Doi-Digital Online Identifier , ISSN National Centre , Zenodo Indexing , International CODEN Service, USA , 

Abstract

ISCHEMIC DIGITAL NECROSIS ON A RIGHT BRACHIOCEPHALIC FISTULA TREATED BY RADIAL ANGIOPLASTY AND AMPUTATION: A CASE REPORT

Imane Halaouate*

ABSTRACT

Introduction: Distal ischemic steal syndrome (DISS) is a rare but serious complication of brachiocephalic arteriovenous fistulas (AVFs) used in chronic hemodialysis. It results from a diversion of blood flow through the AVF at the expense of distal arterial perfusion, potentially leading to digital ischemia and necrosis. Prompt diagnosis and a balanced therapeutic approach are essential to avoid limb-threatening outcomes while preserving vascular access. Case report: We present the case of a 70-year-old male undergoing chronic hemodialysis, who developed ischemic necrosis of the right fourth finger in the context of a functioning right brachiocephalic AVF. Clinical evaluation and Doppler ultrasound revealed absent radial and ulnar pulses and reversed radial artery flow due to long-segment radial artery stenosis. Given that the AVF was the patient’s last viable access site, a conservative strategy was adopted. Endovascular percutaneous angioplasty of the radial artery successfully restored antegrade flow, and surgical amputation of the necrotic finger was performed in the same operative session. Postoperative follow-up showed favorable healing and preserved AVF function without recurrence of ischemic symptoms. Discussion: This case illustrates the importance of individualized, vessel-sparing strategies in managing DISS, particularly in patients with limited vascular access options. Percutaneous angioplasty of forearm arteries represents a safe, effective, and minimally invasive alternative to traditional revascularization procedures in selected cases. Timely intervention can prevent further ischemic damage and avoid the need for major amputation or fistula sacrifice. Conclusion: Early recognition and targeted treatment of AVF-related ischemic complications are crucial to prevent irreversible damage. In patients with limited vascular access, percutaneous revascularization combined with limited surgical intervention may achieve symptom resolution while preserving hemodialysis viability.

[Full Text Article]    [Download Certificate]

Powered By WJPMR | All Right Reserved

WJPMR