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

Mohamad Taha

doi:10.4236/wjcs.2017.73004

Abstract

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.

Highlights

Distal ischemia is a known complication of vascular access placement in patients with end-stage renal disease
Symptoms can vary from mild pain or paresthesia to devastating arterial insufficiency with limb-threatening ischemia
The term ischemic monomelic neuropathy was first used by Wilbourn and associates in 1983

Summary

Introduction

Distal ischemia is a known complication of vascular access placement in patients with end-stage renal disease. M. Taha 28 fested by symptoms such as numbness, pain, and paresthesia and clinical findings including diminished or absent pulses, delayed capillary refill, and in severe cases, impending or frank tissue necrosis in the involved extremity. Ischemic monomelic neuropathy (IMN) is a distinct clinical entity involving dysfunction of multiple upper extremity peripheral nerves either predominantly or exclusively. The term ischemic monomelic neuropathy was first used by Wilbourn and associates in 1983 Their initial report described a clinical entity with arterial insufficiency (ischemic) involving a single extremity (monomelic) and causing selective dysfunction (neuropathy) of multiple peripheral nerves [4]. The key differentiating feature of IMN is that it occurs within hours of fistula or graft creatation It is often disabling and irreversible but does not cause tissue necrosis [5]. I report a case of IMN after left BC AVF operation which was treated successfully by early access ligation, providing a complete review of the literature

Case Report

Review of Literature

Findings

Conclusion