Forearm Amputation Due to Widespread Necrosis Caused by Steal Syndrome

We report a rare case of extensive necrosis due to steal syndrome leading to forearm amputation and review previous reports of necrosis cases. An 83-year-old woman with arteriosclerosis and diabetes mellitus was diagnosed with chronic kidney disease and initiated on hemodialysis. Due to shunt dysfunction and radial artery stenosis, an arteriovenous graft (AVG) was created between brachial artery and basilic vein. Immediately, the patient developed palm pain and an extensive ulceration. Contrast-enhanced computed tomography revealed radial artery disruption at the wrist and ulnar artery occlusion; therefore, internal shunt closure surgery was performed 28 days later, with a diagnosis of steal syndrome. Despite shunt closure, owing to widespread gangrene reaching the wrist, forearm amputation was performed 76 days after the initial intervention. When creating an internal shunt, particularly an AVG, in elderly dialysis patients with peripheral vascular disease or diabetes mellitus, the potential for extensive ischemic necrosis must be carefully considered.