Neurologic and ischemic complications of upper extremity vascular access for dialysis

Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis

“…The initial case reports consisted of sudden and permanent sensory and motor impairment involving multiple nerve groups of a distal limb and were associated with nerve conduction studies showing axonal loss and reduced conduction velocities. [15][16][17] Cases occurring immediately after fistula creation were thought to be due to a transient reduction in blood flow that caused ischemia of the vasa nervorum, but was not prolonged enough to cause tissue loss. 7,15,[17][18][19] It is most commonly associated with diabetes, atherosclerotic vascular disease, and upper arm fistulae.…”

“…Immediate revascularization or ligation of the fistula is required for this acute presentation, but may not prevent permanent nerve damage. 15,17 Involvement of all of the distal nerves of the forearm (radial, ulnar and median nerves) with decreased nerve conduction studies and axonal loss distinguish ischemic monomelic neuropathy from focal nerve injuries such as hematoma, abscess, or venous aneurysm that tend to affect only one nerve. 19,20 Carpal tunnel syndrome tends to be more common in the fistula arm than the contralateral arm, but is distinguished by an abnormal nerve conduction study affecting primarily the median nerve.…”

Critical Hand Ischemia after Angioaccess Surgery: Diagnosis and Treatment

“…Endovascular treatment is the method of choice for proximal arterial stenosis located between the subclavian artery and the brachial artery above the AVF. 7,34,35 Angioplasty can be performed by the femoral or brachial route. When ischemia occurs in association with a wrist AVF, endovascular treatment of proximal lesions on the radial and ulnar artery can correct steal and improve distal perfusion.…”

Preoperative Assessment of the Efficacy of Distal Radial Artery Ligation in Treatment of Steal Syndrome Complicating Access for Hemodialysis

“…Treatment options in our case included reduction in luminal diameter of the shunt (banding technique), graft extension (to increase the circuit resistance), ligation of the radial artery distal to the anastomosis, restoration of ulnar artery flow, the Schanzer and Haimov intervention (interval ligation associated with distal revascularization using a reversed saphenous bypass), or closure of the fistula. 3,5,6 Most authors agree that the banding technique is not a viable option. 7,8 Graft extension uses a synthetic interposition with two venous anastomoses, which increases the risk of restenosis and iterative thrombosis.…”