Treatment of acute hand ischemia following a scald injury in a hemodialysis patient with central venous occlusion: a case report.

Objective: This case report describes a rare presentation of acute digital ischemia in a hemodialysis patient, precipitated by central venous occlusion (CVO). We reveal a unique pathological mechanism: venous hypertension induced by CVO and subsequent forearm edema lead to distal venous congestion and secondary hypoperfusion of the distal limb. Case report: A 56-year-old female on long-term maintenance hemodialysis presented with progressive left forearm swelling and acute digital ischemia following a minor wrist scald. Clinical examination revealed severe pain, numbness, and cyanosis of the digits. Duplex ultrasonography demonstrated massive subcutaneous edema of the forearm and diminished flow in the ulnar artery, alongside a chronically occluded distal radial artery at the arteriovenous fistula (AVF) site. Previous imaging had confirmed ipsilateral subclavian vein occlusion. Given the threat to limb viability, emergency AVF ligation was performed under local anesthesia to reduce forearm venous pressure and increase ulnar artery blood flow. Immediate postoperative recovery was observed, with rapid restoration of digital skin temperature, capillary refill, and resolution of forearm edema. Conclusion: In hemodialysis patients with confirmed central venous obstruction (CVO), significant limb swelling can trigger a reduction in distal limb perfusion, leading to severe ischemic symptoms. Early recognition of this venous-hypertensive mechanism is critical; timely intervention, such as AVF ligation, can reverse ischemia and prevent permanent tissue loss.