Reflex sympathetic dystrophy syndrome due to arteriovenous fistula

Abstract

A patient with end-stage renal disease presented with reflex sympathetic dystrophy syndrome (RSDS) on her left hand 1 month after arteriovenous fistula (AVF) surgery. Magnetic resonance angiography revealed steal syndrome at the AVF level. Bone scintigraphy revealed early-stage RSDS. We considered that arterial insufficiency because of steal phenomenon following AVF surgery and underlying occlusive arterial disease triggered RSDS development.

Dialysis shunt-associated steal syndrome (DASS) following brachial accesses: the value of fistula banding under blood flow control

“…If techniques such as DRIL can be a sufficient therapy in DASS type III, it is unknown because of missing experience. Some authors generally propagate closure of the HA in case of tissue loss (which would be types II and III according to our classification) [11]. In our patients, type II as well as type III were significantly associated with diabetes mellitus.…”

“…Carpaltunnel-syndromes as well as dystrophy syndromes have been described [16,17]. Another rare neurologic manifestation of DASS is the ischemic monomelic neuropathy (IMN), with assumably distal axonopathy in combination with diabetic polyneuropathy or peripheral arteriosclerosis as preconditions [11,18,19]. Neurologic as well as nonneurologic symptoms after DASS can occur acutely or after longer periods [11,17].…”

“…More difficult to evaluate are reversible or irreversible neurologic symptoms. In many cases, their pathogenesis remains unclear [11]. Carpaltunnel-syndromes as well as dystrophy syndromes have been described [16,17].…”

“…A rare but important complication of HA is DASS (2-10% [10,11]). A dialysis access always means a change of the hemodynamic flow of the extremities, which usually does [12].…”

“…Another rare neurologic manifestation of DASS is the ischemic monomelic neuropathy (IMN), with assumably distal axonopathy in combination with diabetic polyneuropathy or peripheral arteriosclerosis as preconditions [11,18,19]. Neurologic as well as nonneurologic symptoms after DASS can occur acutely or after longer periods [11,17]. Several therapeutic options preserving HA function in DASS have been described: Angioplasty [20] as nonoperating intervention and HA banding, DRIL (distal revascularization interval ligature) procedure [6,7], RUDI (revision using distal inflow) procedure [21], and loop-interposition [8,9] as operating techniques.…”