Ischemic Monomelic Neuropathy: Diagnosis, Pathophysiology, and Management

IntroductionHemodialysis access-induced distal ischemia (HAIDI) has been reported to have an incidence of 1%-8%. 1 However, this is based on referred cases requiring surgical treatment. Its true frequency is dependent upon the symptom threshold used to qualify for the diagnosis. Systematic patient evaluation has shown that mild to moderate symptoms occur much more frequently. 2 The reported incidence relates to the upper extremity and is the topic of this review. Access-related distal ischemia can also involve the lower extremity with serious consequences. 3,4 An understanding of HAIDI and the appropriate role of the interventional nephrologist in its management is important when patients present with symptoms suggestive of HAIDI. Herein, the pathophysiology of the syndrome is discussed followed by recommendations for its diagnosis and management and the basis for the recommendations. These recommendations ASDIN white paper: Assessment and management of hemodialysis accessinduced distal ischemia by interventional nephrologists AbstractAlthough not common, hemodialysis access-induced distal ischemia is a serious condition resulting in significant hemodialysis patient morbidity. Patients with signs and symptoms suggestive of hand ischemia frequently present to the general and interventional nephrologist for evaluation. In order to care for these cases, it is necessary to understand this syndrome and its management. Most cases can be managed conservatively without intervention. Some cases requiring intervention may be treated using techniques within the scope of practice of the interventional nephrologists while other cases require vascular surgery. In order for the interventional nephrologists to evaluate and manage these cases in a timely and appropriate manner, practice guidelines are presented.

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“…Nerve conduction studies can be used to confirm the diagnosis. 47 Most physicians recommend immediate access ligation.…”

Section: Differential Diagnosismentioning

confidence: 99%

ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists

et al. 2019

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“…Ischemic monomelic neuropathy (IMN) is one of the rare complication encountered after arteriovenous (AV) fistula graft surgery. As the name suggests, ischemia or the impaired blood supply is the main pathognomonic reason for ischemic monomelic neuropathy [1]. IMN is characterized by symptoms of acute pain, numbness, paresthesia along with the motor weakness, and it is most likely to occur in patients with brachiocephalic vascular graft [2].…”

Section: Introductionmentioning

confidence: 99%

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

Datta¹,

Mahal²,

Govindarajan³

2019

Cureus

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Ischemic monomelic neuropathy (IMN) is a rare complication of vascular access in the hemodialysis patients, characterized by multiple mononeuropathies in the absence of clinical ischemia. Most commonly seen in the female gender, diabetes mellitus, and it must be differentiated from vascular steal syndrome, where we see clinical ischemia as the main pathognomonic feature. Early recognition of the symptoms and prompt intervention was shown to be beneficial. A delay in the treatment can lead to irreversible damage to the nerves and muscles. This article is depicting a case of an elderly male patient who presented with signs and symptoms of IMN which developed after arteriovenous (AV) fistula graft surgery.

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“…Distal peripheral embolization poses high risk of limb loss, while IMN can cause permanent functional loss, both of which can be prevented by increasing distal perfusion. 7 However, in this case, it was thought that IMN was less likely given the thrombus found on preoperative ultrasonography and the intraoperative angiogram showing a filling defect in the palmar arch.…”

Section: Discussionmentioning

confidence: 78%

Radiofrequency Ablation of the Stellate Ganglion for Management of Acute Digital Ischemia: A Case Report

2018

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The authors present a report of a pulsed radiofrequency ablation of the stellate ganglion performed on a patient with microemboli to the hand from a thrombosed abandoned arteriovenous fistula. The patient was initially managed using vasodilators and anticoagulation. However, the patient’s skin mottling, pain, and decreased strength persisted. Ablation of the stellate ganglia increased perfusion to his hand and likely prevented amputation that has lasted for approximately 1 year. While radiofrequency ablation is more commonly used for pain syndromes, this is an example of its use in the treatment and potential treatment of acute ischemia.

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Ischemic Monomelic Neuropathy: Diagnosis, Pathophysiology, and Management

Cited by 12 publications

References 10 publications

ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists

ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists

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

Radiofrequency Ablation of the Stellate Ganglion for Management of Acute Digital Ischemia: A Case Report

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