Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review

Thermann, Florian; Kornhuber, Malte

doi:10.5301/jva.2011.6365

Cited by 33 publications

(35 citation statements)

References 28 publications

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“…Ischemic monomelic mononeuropathy, identified in three patients, is a rare complication affecting a fistula limb requiring urgent closure of the fistula for recovery. 19,20 It most commonly occurs in patients with diabetes mellitus 21 ; in our study two patients with ischemic monomelic mononeuropathy had diabetes.…”

Section: Discussionmentioning

confidence: 99%

Neuropathy in the Hemodialysis Population: A Review of Neurophysiology Referrals in a Tertiary Center

et al. 2012

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This was a retrospective observational study of neurophysiology referrals over 8 years from a tertiary referral center in Ireland. A total of 68 of the 73 referrals yielded one or more abnormalities. Thirty-nine (53%) patients had one or more mononeuropathies; iatrogenic mononeuropathies believed to be associated with arterio-venous fistula creation occurred in 15 patients. Polyneuropathy was identified in 43 patients (59%). Access to an experienced neurophysiology department offers valuable insight into dialysis-associated neuropathies, especially when associated with arterio-venous fistulae.

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Section: Discussionmentioning

confidence: 99%

Neuropathy in the Hemodialysis Population: A Review of Neurophysiology Referrals in a Tertiary Center

et al. 2012

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“…Unfortunately, the observed hemodynamic benefits of the DRIL procedure failed to relieve all of the precipitating neurological complaints as a small subset of patients had persistent paresthesias. We hypothesize that these patients likely had a severe, irreversible ischemic nerve injury prior to the DRIL 29 . It has been our anecdotal impression that this irreversible nerve injury can occur fairly quickly in terms of the time elapsed from access creation, and suggests importance in the timing of DRIL.…”

Section: Discussionmentioning

confidence: 99%

Prediction of graft patency and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia

Scali

Chang

Raghinaru

et al. 2013

Journal of Vascular Surgery

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Objective The treatment goals for access related hand ischemia (ARHI) are to reverse symptoms and salvage the access. Many procedures have been described, but the optimal treatment strategy remains unresolved. In an effort to guide clinical decision making, this study was undertaken to document our outcomes for distal revascularization and interval ligation (DRIL) and identify predictors of bypass patency and patient mortality. Methods A retrospective review was performed of all patients who underwent DRIL at the University of Florida from 2002–2011. Diagnosis of ARHI was based primarily upon clinical symptoms with non-invasive studies used to corroborate in equivocal cases. Patient demographics, procedure-outcome variables and re-interventions were recorded. Bypass patency and mortality were estimated using cumulative incidence and Kaplan-Meier methodology, respectively. Cumulative incidence and Cox regression analysis were performed to determine predictors of bypass patency and mortality, respectively. Results 134 DRILs were performed in 126 patients (age 57±12yrs (mean±SD)) following brachial artery-based access. The post-operative complication rate was 27% (19%-wound), and 30-day mortality was 2%. The wrist/brachial (WBI) and digital/brachial (DBI) indices increased 0.31±0.25 and 0.25±0.29, respectively. Symptoms resolved in 82% of patients, and 85% continued to use their access. Cumulative incidences of loss of primary and primary-assisted patency rates were 5±2%, 4±2% and 22±5%, 18±5% at 1 and 5 years, respectively with a mean follow-up of 14.8 months. Univariate predictors of primary patency failure were DRIL complications (3.3; 1.2–8.9, p=0.02), configuration other than brachiobasilic/brachiocephalic autogenous access (3.4; 1.4–8.3, p=0.009), and ≥2 prior access attempts (4.1; 1.6–10.4, p=0.004). Brachiocephalic access configuration (0.2; 0.04–0.8, p =0.02), and autogenous vein conduit (0.2; 0.06–0.58, p=0.004) were predictors of improved bypass patency. All-cause mortality was 28% and 79% at 1 and 5 years, respectively. Multi-variable predictors of mortality were age > 40 (8.3; 2.5–33.3, p =0.0004), grade 3 ischemia (2.6; 1.5–4.6, p=0.0008), complication from DRIL (2.4; 1.3–4.5, p=0.004), and smoking history (2.2; 1.3–4, p=0.007). Patients with no prior access attempts had lower predicted mortality (0.5; 0.3–0.9, p=0.02). Conclusion The DRIL procedure effectively improves distal perfusion and reverses the symptoms of ARHI while salvaging the access, but the long-term survival of these patients is poor. Given the poor survival, pre-operative risk stratification is critical. Patients at high risk for DRIL failure and mortality may be best served with alternate remedial procedures.

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“…It is probably a ‘steal’ phenomenon, where the vascular access site depletes blood supply to the distal nerve causing axonal loss 23. Additional risk factors include diabetes and severe peripheral vascular disease.…”

Section: Neurological Complications Associated With Dialysismentioning

confidence: 99%

Neurological complications of renal dialysis and transplantation

Karunaratne

Taube²,

Khalil

et al. 2017

Pract Neurol

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Neurological complications from renal replacement therapy contribute significantly to morbidity and mortality in patients with renal failure. Such complications can affect either the central or peripheral nervous systems. Most neurological disturbances associated with the uraemic state do not respond fully to renal replacement therapy. There are also complications specifically associated with dialysis and transplantation. A multidisciplinary approach, involving both nephrologists and neurologists, is critical for the diagnosis and effective management of these disorders.

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Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review

Cited by 33 publications

References 28 publications

Neuropathy in the Hemodialysis Population: A Review of Neurophysiology Referrals in a Tertiary Center

Neuropathy in the Hemodialysis Population: A Review of Neurophysiology Referrals in a Tertiary Center

Prediction of graft patency and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia

Neurological complications of renal dialysis and transplantation

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