Surgical intervention for upper extremity nerve compression related to arteriovenous hemodialysis accesses

Abstract

Objective: Chronic renal failure patients with arteriovenous hemodialysis access may exhibit pain and neurological complaints due to local nerve compression by the access conduit vessels of autogenous arteriovenous fistulas or the prosthesis of arteriovenous grafts. In this study, we have examined the results of surgical intervention for vascular access–related nerve compression in the upper extremity. Methods: A single center retrospective study was performed of all patients referred for persistent pain and neurological complaints after vascular access surgery for hemodialysis. There were four brachial-cephalic, three brachial-basilic upper arm arteriovenous fistulas, and three prosthetic arteriovenous grafts. All patients had pain and sensory deficits in a distinct nerve territory (median nerve: 6; median + ulnar nerve: 1; medial cutaneous nerve: 1), and two patients had additional motor deficits (median nerve). Results: A total of 10 patients (mean age: 59 years; range: 25–73 years; 2 men; 4 diabetics) were treated by surgical nerve release alone (2 patients) or in combination with access revision (8 patients). Mean follow-up was 23 months (range: 8–46 months). Direct complete relief of symptoms was achieved in six patients. Three patients had minor complaints, and one patient had a reoperation with good success. Conclusion: Vascular access–related nerve compression is an uncommon cause for pain, sensory and motor deficits after vascular access surgery. Surgical nerve release and access revision have good clinical outcome with relief of symptoms and maintenance of the access site in the majority of patients.

Median Nerve and Ulnar Nerve Entrapment with Cubital Tunnel Syndrome in a Hemodialysis Patient Following Creation of an Arteriovenous Fistula

“…Retrospectively, this EMG finding misled us leading to delay in surgical intervention. Similar to our patient a complete or partial relief has been reported in 10 patients who had surgical intervention for upper extremity nerve compression related to arteriovenous hemodialysis access [15].…”

“…Multiple etiologies need to be considered to plan the appropriate and expedited management strategy (Table 1 ) in a patient who has symptoms such as hand pain or muscle weakness or sensory loss in the ipsilateral arm of the AVF following surgical creation [ 2 , 15 ]. The etiology is varied and knowledge of the anatomy of the vascular and nerve supply is key to diagnose and intervene to prevent complications.…”

Intractable arteriovenous access-related pain relieved after a single, pain-free hemodialysis session under selective block of the sensory nerves in the upper limb: A psychosocial factorial case

“…3 Specific treatments for rare neuropathic AVA-related pain, which also have biological action but underestimated to date, have also been reported. 4,9 For example, we and Tordoir et al described the efficacy of neurolysis surgery for nerves compressed by AVA-related runoff veins and/or inflow arteries. 4,9 The relevance of these neuropathic factors to AVA-related pain should be further elucidated in future research.…”

“…4,9 For example, we and Tordoir et al described the efficacy of neurolysis surgery for nerves compressed by AVA-related runoff veins and/or inflow arteries. 4,9 The relevance of these neuropathic factors to AVA-related pain should be further elucidated in future research.…”

Peripheral embolism as first and only clinical symptom of a true aneurysmal degeneration of the radial artery after ligation of a radiocephalic fistula

“…Delayed AVF ligation may lead to various complications such as embolization due to thrombus formation, venous hypertension, steal syndrome, high-output cardiac failure, overmaturation, infection, nerve compression, arteriomegaly of the inflow artery, venomegaly of the outflow vein, rarely aneurysms, and even more scarcely aneurysmal degeneration of the inflow artery. 2,3 Therefore, a periodic clinical and radiological follow-up of the AVF is recommended after kidney transplant but often not performed in clinical practice. 4 More than one-third of the AVFs close spontaneously after transplantation.…”