Digital ischaemia in a renal transplant patient

Iain Moore, Saeed Ahmed, John A. Sayer and Michael K. Ward

Freeman Hospital, Nephrology, Newcastle upon Tyne, Northumbria, UK

Correspondence and offprint requests to: Saeed Ahmed, Freeman Hospital, Nephrology, Newcastle upon Tyne, Northumbria, UK. Email: saeed_ahmed29{at}hotmail.com

Keywords: arteriovenous fistula; ischaemia

A renal transplant patient presented with a sudden onset of painful left index finger (Figure 1). He had a palpable left radial pulse with an absent ulnar pulse. The left index finger was cold and dusky with reduced capillary refill and sensation. There were multiple splinter haemorrhages visible in the left hand only (Figure 2). He had a non-functional arteriovenous fistula (AVF) at the left wrist (Figure 3). Initially he was treated with intravenous heparin and analgesia followed by an arteriogram, which showed an aneurysm of the left radial artery, poor ulnar and interosseous arterial flow and occluded index finger digital arteries (Figure 4). It was felt that he had suffered a shower of emboli from the aneurysm. He was subsequently anticoagulated with warfarin.



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Fig. 1. Digital ischaemia of the left index finger.

 


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Fig. 2. Multiple splinter haemorrhages of the left hand fingers.

 


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Fig. 3. Old non-functional AVF at the left wrist.

 


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Fig. 4. Arteriogram of the left hand showing occluded index finger digital arteries and no flow in the ulnar artery.

 
This case highlights the possibility that a redundant fistula can be a source of emboli, which can occlude the distal circulation.

Conflict of interest statement. None declared.





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