Vascular steal syndrome and ischaemic monomelic neuropathy: two variants of upper limb ischaemia after haemodialysis vascular access surgery

Miles, Anne Marie V.

doi:10.1093/ndt/14.2.297

Cited by 84 publications

(61 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This neuropathy generally is symmetrical. This differs from ischemic monomelic neuropathy (IMN), which is a complication of vascular access that is observed almost exclusively in patients with diabetes, particularly those with preexisting neuropathy (29,30). This entity is characterized by the development of acute pain, weakness, and paralysis of forearm and hand muscles and often is associated with sensory changes.…”

Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

Arteriovenous Access and Hand Pain

León

Asif

2007

Clinical Journal of the American Society of Nephrology

125

104

View full text Add to dashboard Cite

An ischemic hand in a hemodialysis patient is a serious condition. It causes significant pain and discomfort but also can lead to tissue necrosis and the eventual loss of digits and even the entire hand. Although stealing of blood away from the high-resistance forearm arteries into the low-resistance arteriovenous access generally is assumed to be the cause, a great majority of both wrist and elbow accesses demonstrate retrograde flow without any evidence of hand pain or ischemia. Consequently, demonstration of retrograde flow alone does not predict or indicate the existence of distal ischemia. In this context, the term "arterial steal syndrome" is a misnomer to indicate the presence of peripheral ischemia. Recent studies have shown that, in many cases, arterial stenotic lesions cause distal hypoperfusion and result in hand ischemia. In other cases, distal arteriopathy as a result of generalized vascular calcification and diabetes is the culprit. Because any or a combination of the three mechanisms (retrograde flow, stenotic lesions, and distal arteriopathy) can lead to peripheral ischemia, distal hypoperfusion ischemic syndrome is a more appropriate term to denote hand ischemia. Treatment should start with a detailed history and physical examination to help rule out other (nonischemic) causes of hand pain. A complete arteriogram to evaluate the circulation of the extremity from the aortic arch to the palmar arch is essential. The choice of treatment modality and procedure to apply should be based on this evaluation. This report reviews the pathophysiology and presents current strategies to ameliorate distal hypoperfusion ischemic syndrome.

show abstract

Section: Clinical Features and Differential Diagnosismentioning

confidence: 99%

Arteriovenous Access and Hand Pain

León

Asif

2007

Clinical Journal of the American Society of Nephrology

125

104

View full text Add to dashboard Cite

show abstract

“…11,12 TcPO 2 measurements are sensitive to all the above factors because they directly reflect the oxygenation of the target tissues. The superiority of this method compared with segmental pressure measurements is particularly evident in diabetic patients, 13,14 who are more prone to develop severe post-AVA tissue hypoxia and ischemic monomelic neuropathy 15,16 (post-AVA nerve hypoxia in which no or only mild hemodynamic alterations are detected), currently diagnosed only by nerve conduction studies.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Transcutaneous Oxygen Tension in Limbs with Arteriovenous Hemodialysis Access

Harissis

Koliousi

Matsagas

et al. 2008

Dialysis & Transplantation

View full text Add to dashboard Cite

BACKGROUND The purpose of the present study was to investigate hypoxemic complications of limbs with arteriovenous access by means of transcutaneous oximetry. METHODS The study was a prospective assessment of 31 limbs with arteriovenous access using transcutaneous oximetry. Each limb was measured 4 times: before arteriovenous construction, the first post‐operative day, the first post‐operative month, and the fourth post‐operative month. The contralateral limb was used as control for every measurement. RESULTS The first postoperative day was characterized by an acute drop in the tissue oxygenation of the limb with arteriovenous access (p = 0.03). This hypoxia was compensated for in the first month by a gradual return of transcutaneous oxygen values to pre‐operative levels. Two patients developed a steal syndrome, characterized by abnormally low transcutaneous oxygen (< 40 mmHg). CONCLUSION Transcutaneous oximetry is a simple and accurate method for objectively assessing the whole spectrum of alterations in tissue oxygenation (from transient hypoxia to steal syndrome) caused by arteriovenous access.

show abstract

“…Two distinct variants of upper extremity ischemia can be seen following the placement of AVFs or AVGs [3].…”

Section: Review Of Literaturementioning

confidence: 99%

“…Diagnosis and treatment are often delayed, and even with early intervention, neurologic dysfunction may be irreversible [3].…”

Section: Introductionmentioning

confidence: 99%

Ischemic Monomelic Neuropathy after a Brachio-Cephalic AVF Creation: A Case Report and Review of Literature

Taha¹

2017

WJCS

View full text Add to dashboard Cite

Ischemic monomelic neuropathy (IMN) is an under-diagnosed and disabling complication of upper extremity hemodialysis access. The hemodynamic disturbance that occurs during the time of access creation can lead to both neurologic and ischemic complications. These complications are most commonly seen following proximal procedures involving the upper limbs. Diagnosis and treatment are often delayed, and even with early intervention, neurologic dysfunction may be irreversible. IMN can lead to significant long-term disability. Almost all cases of IMN occur with brachial artery-based access, procedures and the vast majority of patients are diabetic and females. I report a case of IMN after left BC AVF operation which was treated successfully by early access ligation, providing a review of the literature.

show abstract

Vascular steal syndrome and ischaemic monomelic neuropathy: two variants of upper limb ischaemia after haemodialysis vascular access surgery

Cited by 84 publications

References 0 publications

Arteriovenous Access and Hand Pain

Arteriovenous Access and Hand Pain

Measurement of Transcutaneous Oxygen Tension in Limbs with Arteriovenous Hemodialysis Access

Ischemic Monomelic Neuropathy after a Brachio-Cephalic AVF Creation: A Case Report and Review of Literature

Contact Info

Product

Resources

About