Our Summary

This research paper discusses Dialysis Access Steal Syndrome (DASS), a condition that can occur after a specific type of surgery used to help with dialysis treatment. The surgery creates a connection between an artery and a vein, which can sometimes cause blood to be diverted away from the limb. This can lead to symptoms that suggest the limb isn’t getting enough blood.

A rare variation of this condition is called Ischemic Monomelic Neuropathy (IMN), which is known to cause severe limb pain and can result in both motor and sensory defects. This can happen immediately after the dialysis surgery or intervention.

The paper presents a case where IMN occurred after a procedure was done to help the development of this artery-vein connection. The exact cause of IMN isn’t fully understood, but this case adds to our knowledge of the condition.

FAQs

  1. What is Dialysis Access Steal Syndrome (DASS) and when does it occur?
  2. What is Ischemic Monomelic Neuropathy (IMN) and what are its clinical manifestations?
  3. Can the onset of IMN occur immediately after the creation of dialysis access?

Doctor’s Tip

A helpful tip a doctor might tell a patient about AV fistula creation is to be aware of the potential for dialysis access steal syndrome, which can lead to symptoms of limb ischemia. It is important to monitor for any signs of limb pain, changes in sensation, or motor defects following the creation of an AV fistula and to promptly report any concerning symptoms to your healthcare provider. Early recognition and management of dialysis access steal syndrome can help prevent complications and improve outcomes.

Suitable For

Patients who are typically recommended for AV fistula creation include those with end-stage renal disease requiring hemodialysis, particularly those with poor vascular access for dialysis. These patients may have advanced chronic kidney disease, diabetes, hypertension, or other conditions that require long-term renal replacement therapy. AV fistulas are preferred over other types of vascular access due to their lower rates of infection and longer patency, making them the recommended choice for most hemodialysis patients.

Timeline

  • Before AV fistula creation: The patient undergoes evaluation by a healthcare provider to determine the need for dialysis access. Once deemed necessary, the patient undergoes surgical or endovascular creation of an AV fistula, which involves connecting an artery to a vein to create a high-flow access for dialysis.

  • After AV fistula creation: The patient may experience pain, swelling, and bruising at the site of the AV fistula immediately following the procedure. Over the following weeks to months, the AV fistula undergoes maturation and becomes suitable for use in dialysis. However, in some cases, complications such as dialysis access steal syndrome (DASS) may occur, leading to symptoms of limb ischemia due to diversion of arterial flow from the distal extremity.

  • In the case of ischemic monomelic neuropathy (IMN), a rare subtype of DASS, the patient may experience severe distal limb pain that progresses to motor and sensory defects following assisted maturation of the AV fistula. The onset of IMN can be immediate or delayed after dialysis access creation or intervention. Management of IMN typically involves addressing the underlying vascular issue causing the steal syndrome and providing symptomatic relief for the neuropathic symptoms.

What to Ask Your Doctor

  1. What is an arteriovenous (AV) fistula and why is it being recommended for me?
  2. What are the potential risks and complications of AV fistula creation?
  3. How will the AV fistula be created and what is the recovery process like?
  4. How will I know if I am experiencing symptoms of dialysis access steal syndrome (DASS) or ischemic monomelic neuropathy (IMN)?
  5. What should I do if I experience severe limb pain or other symptoms after the AV fistula creation procedure?
  6. How often should I follow up with you after the AV fistula creation for monitoring and evaluation?
  7. Are there any lifestyle changes or precautions I should take to prevent complications after the AV fistula creation?
  8. Are there any alternative options to AV fistula creation for dialysis access that I should consider?
  9. What is the long-term outlook for someone who has undergone AV fistula creation?
  10. Are there any specific factors or conditions in my medical history that may impact the success of the AV fistula creation procedure?

Reference

Authors: Sonnabend K, Park S, Shah K, Lipnik AJ, Niemeyer MM. Journal: Semin Intervent Radiol. 2023 Jul 20;40(3):290-293. doi: 10.1055/s-0043-1769765. eCollection 2023 Jun. PMID: 37484452