Ischemic Monomelic Neuropathy after Arteriovenous Fistula Surgery: Clinical Features, Electrodiagnostic Findings, and Treatment

Datta, Sorabh; Mahal, Shanan; Govindarajan, Raghav

doi:10.7759/cureus.5191

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…A case report published the same month in which our patient presented represented a similar patient presentation after one month of IMN with slightly less contracture. After ligation of the fistula, the patient showed vast improvement in the median nerve distribution, however, it showed a slower return to function than the immediate results we experienced in our patient [6]. Another case reported in 2017, claimed IMN within hours of arteriovenous graft creation at the upper arm, subsequently ligated the graft on postoperative day 1 when the symptoms continued to worsen [7].…”

Section: Discussioncontrasting

confidence: 47%

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

Re¹,

Asaad²,

Valentin-Capeles³

et al. 2020

Asp Biomed Clin Case Rep

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We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

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Section: Discussioncontrasting

confidence: 47%

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

Re¹,

Asaad²,

Valentin-Capeles³

et al. 2020

Asp Biomed Clin Case Rep

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show abstract

“…In contrast, DASS can be diagnosed by the absence or weak radial pulse, delay in capillary refill, discoloration of fingers, cool hands, symptoms improve with compression of AV access, and skin and muscles are involved more than nerves. 11 Our patient had strong radial pulse, no skin findings, hand was warm to touch and symptoms abated immediately after ligation of fistula Thus, conglomeration of all the symptoms, clinical findings and response to treatment suggestive of IMN.…”

Section: Discussionmentioning

confidence: 58%

A Case of Ischemic Monomelic Neuropathy after Arteriovenous Fistula Placement

Sangani¹,

Pokal²,

Noel³

et al. 2023

Journal of Community Hospital Internal Medicine Perspectives

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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.

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“…A rare immediate complication is ischemic monomelic neuropathy (IMN), which has a similar pathogenicity. IMN is characterized by acute pain, paresthesia, and weakness immediately following the access creation, which is usually in the arm, and it is also an indication for access ligation to prevent permanent sensory and motor damage ( 29 , 91 ).…”

Section: Arteriovenous Graftsmentioning

confidence: 99%

The evolving panorama of vascular access in the 21st century

Neyra

Wazir²

2022

Front. Nephrol.

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There are three major types of hemodialysis vascular access: hemodialysis catheters, arteriovenous grafts, and arteriovenous fistulas. Arteriovenous fistulas provide the best access due to their reliability and long-term patency. They are recommended by the current Kidney Disease Outcomes Quality Initiatives (K-DOQI) guidelines; however, not all patients benefit from arteriovenous fistulas due to poor maturation or a lack of adequate vasculature. Currently, hemodialysis is initiated via catheters in the majority of patients. Catheters are associated with high morbidity and mortality due to infection, lower quality of dialysis, and the development of central vein stenosis. The varied responses of patients to the different access types exemplify the need to choose the “right access for the right patient” based on scores that can predict death risk and progression of chronic kidney disease. Additionally, vascular access, often referred to as the “Achilles’ heel” of hemodialysis patients, represents a significant percentage of the Medicare budget that continues to increase yearly. The purpose of this paper is to review the current literature on the management of vascular access complications and infection treatment and prevention. The paper also explores emerging research regarding the devices and methods to improve access outcomes such as early cannulation arteriovenous grafts, endovascular arteriovenous fistula creation, and regenerative grafts with resorbable scaffolds, among others. The data were collected through literature searches via PubMed, Athens and web search engines.

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Ischemic Monomelic Neuropathy after Arteriovenous Fistula Surgery: Clinical Features, Electrodiagnostic Findings, and Treatment

Cited by 5 publications

References 16 publications

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

A Case of Ischemic Monomelic Neuropathy after Arteriovenous Fistula Placement

The evolving panorama of vascular access in the 21st century

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