Our Summary

This research paper discusses a rare condition called ischemic monomelic neuropathy, which can sometimes occur after a medical procedure that connects an artery and a vein (known as an arteriovenous or AV fistula) for kidney dialysis. This condition happens when the blood that should be going to the hand is redirected, causing harm to the nerves in the hand and leading to symptoms like overall muscle pain, weakness, and a warm hand with detectable pulses. These symptoms usually start within the first hour after the AV fistula procedure. This complication can be very serious and could even cause permanent disability. The paper presents two cases where this condition occurred following the creation of an AV fistula in the upper arm for dialysis.

FAQs

  1. What is ischemic monomelic neuropathy and how is it related to the creation of an arteriovenous fistula?
  2. What symptoms can occur after the creation of an AV fistula?
  3. What are the potential complications of ischemic monomelic neuropathy after the creation of a brachiocephalic AV fistula for hemodialysis access?

Doctor’s Tip

One helpful tip a doctor might tell a patient about AV fistula creation is to closely monitor any changes in sensation, muscle strength, or temperature in the affected extremity after the procedure. It is important to report any unusual symptoms to your healthcare provider immediately to prevent potential complications such as ischemic monomelic neuropathy. Regular follow-up appointments with your healthcare team are essential to monitor the health of the AV fistula and ensure proper blood flow to the extremity.

Suitable For

Patients with end-stage renal disease who require hemodialysis are typically recommended AV fistula creation as the preferred method of vascular access. However, certain patients may be at higher risk for complications such as ischemic monomelic neuropathy, including those with underlying vascular disease, diabetes, or peripheral neuropathy. Additionally, patients with a history of prior AV fistula complications or those with small or fragile blood vessels may also be at increased risk. It is important for healthcare providers to carefully assess each patient’s individual risk factors before recommending AV fistula creation.

Timeline

Before AV fistula creation:

  • Patient undergoes evaluation and assessment for need of hemodialysis
  • AV fistula is planned and scheduled for creation
  • Patient may undergo pre-operative testing and preparation

After AV fistula creation:

  • Within the first hour after creation, patient may experience global muscle pain, weakness, and a warm hand with palpable pulses
  • Patient may be diagnosed with ischemic monomelic neuropathy
  • Treatment and management may include pain management, physical therapy, and monitoring for permanent disability
  • Long-term follow-up may be necessary to assess for any ongoing complications or symptoms

What to Ask Your Doctor

  1. What are the potential risks and complications associated with AV fistula creation?
  2. How will the AV fistula affect blood flow to the affected extremity?
  3. What symptoms should I watch for after the AV fistula is created?
  4. How can ischemic monomelic neuropathy be diagnosed and treated?
  5. Are there any specific precautions or lifestyle changes I should make to prevent complications with the AV fistula?
  6. How frequently should I have follow-up appointments to monitor the health of the AV fistula and my overall well-being?
  7. Are there any specific exercises or activities I should avoid to protect the AV fistula and prevent ischemic monomelic neuropathy?
  8. Will I need any additional medications or treatments to manage any symptoms or complications that may arise from the AV fistula creation?
  9. What is the long-term outlook for my health and well-being following the creation of the AV fistula?
  10. Are there any alternative treatment options available if complications arise from the AV fistula creation?

Reference

Authors: Sheetal S, Byju P, Manoj P. Journal: J Postgrad Med. 2017 Jan-Mar;63(1):42-43. doi: 10.4103/0022-3859.194221. PMID: 27853044