Carpal Tunnel Release Surgery and Venous Hypertension in Early Hemodialysis Patients without Amyloid Deposits

Abstract

Aim. Carpal tunnel syndrome (CTS) is one of the frequent problems of the patients who underwent hemodialysis (HD). The role of venous hypertension due to arteriovenous fistula (AVF) has not been clarified completely; therefore, we aimed to investigate the role of venous hypertension due to AVF in hemodialysis patients who had CTS. Patients and Methods. We included 12 patients who had been receiving HD treatment for less than 8 years and the newly diagnosed CTS patients with the same arm of AVF. All patients were diagnosed clinically and the results were confirmed by both nerve conduction studies and electromyography. Open carpal tunnel release surgery was performed on all of them. Venous pressure was measured in all patients before and after two weeks of surgery. Results. There were significant differences before and after the surgery with regard to pressures (P > 0.05). After the surgery, all carpal ligament specimens of the patients were not stained with Congo red for the presence of amyloid deposition. Conclusion. Increased venous pressure on the same arm with AVF could be responsible for CTS in hemodialysis patients. Carpal tunnel release surgery is the main treatment of this disease by reducing the compression on the nerve.

Carpal tunnel syndrome in patients with arteriovenous fistula for haemodialysis: A narrative review of the current literature

“…25 Warren also found that venous pressures were significantly raised before HD, 27 while Kocyigit found that venous pressure was significantly reduced following CTS decompression. 23 Moreover in the latter study, amyloid deposition as stained by Congo red was absent in all of their patients biopsy specimens. 23 Both of these studies point towards venous hypertension as a possible aetiological factor in CTS pathogenesis, however, do not elucidate on underlying mechanism for reduction in venous pressure post treatment.…”

“…23 Moreover in the latter study, amyloid deposition as stained by Congo red was absent in all of their patients biopsy specimens. 23 Both of these studies point towards venous hypertension as a possible aetiological factor in CTS pathogenesis, however, do not elucidate on underlying mechanism for reduction in venous pressure post treatment. β2-microglobulin amyloid deposits are another proposed aetiological factor in CTS with AVF and was found in all biopsied samples after surgical decompression in 1 study of 21 patients.…”

“…In a case report by Harding, only one patient had temporary relief from prednisolone injection. 23 In a further case report, a single patient was treated conservatively with splinting with partial relief. 25 In the authors' practice, minimal symptoms with minor neurophysiological changes are treated with non-operative measures such as splinting, activity modification and steroid injection.…”

“…Nevertheless, six of the eight analysed studies utilised nerve conduction studies (NCS) to aid diagnosis. [22][23][24][25][26] It is important to note that uraemic peripheral neuropathy may also present in a similar fashion to CTS. Interestingly, generalised sensory and motor neuropathy was diagnosed in 12 patients (19%) as detected by neurophysiology.…”

Association between low serum prealbumin levels and carpal tunnel syndrome in maintenance hemodialysis patients

“…CTS affects 30-50% patients who have been on hemodialysis for over 10 years and over 80% patients who have been on hemodialysis for over 30 years. Specific factors contribute to the development of carpal tunnel syndrome in patients on chronic hemodialysis, including b2-microglobulin (b2-M) fiber deposits and arteriovenous (AV) fistula [5][6][7][8]. Malnutrition-inflammation-atherosclerosis syndrome is a common cause of increased mortality in chronic kidney disease [9][10][11].…”