A Case of Ischemic Monomelic Neuropathy after Arteriovenous Fistula Placement

Abstract

Ischemic monomelic neuropathy (IMN) is a relatively uncommon and under-recognized complication of vascular access creation for arteriovenous (AV) fistula in hemodialysis patients. They usually develop distal muscle weakness, sensation loss, and severe acute pain without muscle necrosis soon after AV fistula creation. Physicians should be aware of this condition as prompt diagnosis and timely vascular interventions are necessary to save the limbs and prevent permanent functional disability. Once the diagnosis of IMN is made, the patients will need emergent ligation of the fistula to restore the distal perfusion. We report a case of a 59-year-old male patient with End-stage Renal Disease on hemodialysis who developed severe pain, weakness, and loss of sensation in the left arm a few hours after left brachiocephalic vascular access creation. He was subsequently diagnosed with ischemic monomelic neuropathy and underwent emergent AV fistula ligation. Symptoms were relieved immediately after the ligation.