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Complications of Open Arterial Vascular Surgery
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Ischemic monomelic neuropathy is seen in less than 0.5% of access placements [49]. It is usually associated with brachial-based accesses, seen in diabetic patients, and develops very quickly after access placement. It is differentiated from classic steal by the presence of what appears to be adequate hand perfusion and color. It is manifested by pain and severe weakness of the muscles of the hand and forearm. It is thought to be related to relative ischemia of nerves and is treated by either banding or ligation of the access. It should be differentiated from carpal tunnel syndrome, which has increased prevalence in dialysis patients but is more insidious in onset and has symptoms limited to the median nerve distribution.
Complications of hemodialysis access
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Mia Miller, Prakash Jayanthi, William Oppat
There are several causes of neuropathy in the dialysis patient, with 70% of dialysis patients experiencing it in some form.35 These include entrapment causing peripheral nerve compression, uremic neuropathy, diabetic polyneuropathy, and most devastatingly of all, ischemic monomelic neuropathy (IMN). IMN is a rare and specific type of ischemia affecting only nerves. This complication was first described by Wilbourn et al. in 1983 as a condition with arterial insufficiency involving a single extremity (monomelic) and causing selective dysfunction (neuropathy) of multiple peripheral nerves.53 Immediately after surgery, there is steal that results in hypoperfusion of the vasa nervosum, as described by Kelly et al. using electron microscopy.54 This causes damage to distal nerve fibers initiating severe acute neurologic symptoms including pain, paresthesias, numbness in median, radial, and/or ulnar nerves distally, as well as motor weakness or paralysis. This devastating complication can result in permanent disability, even if the fistula or graft is ligated immediately after surgery. IMN differs from steal syndrome in that it is irreversible, exhibits no tissue necrosis, and the hand is usually warm with a palpable pulse or audible Doppler signal. The differential diagnosis of IMN includes vascular steal, complications of axillary block anesthesia, patient positioning, carpal tunnel syndrome, and postoperative pain or swelling.55,56 Risk factors include female gender, long-standing diabetes with prior peripheral neuropathy, and peripheral vascular disease.
Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies
Published in Expert Review of Clinical Pharmacology, 2019
In general, neurologic complications are very common in patients with CKD and every patient with ESKD has more than one complication. They involve the central (CNS), peripheral (PNS), and autonomic (ANS) nervous systems. CNS complications include cognitive deterioration [4–6], encephalopathy [7,8], seizures [7,9,10], asterixis [11], myoclonus [12,13], restless leg syndrome (RLS) [14–16], central pontine myelinolysis [17], tetany [18], cerebrovascular stroke, [19–22] cranial neuropathy [23–25], and extrapyramidal movement disorders which include parkinsonism, chorea, and dystonia [26–34]. PNS and ANS complications include peripheral neuropathy [35–37], autonomic neuropathy [38–43], carpal tunnel syndrome [44], ischemic monomelic neuropathy and subacute vascular steal syndrome [45–47], and myopathy [48]. Neurologic complications contribute largely to the morbidity and mortality in patients with kidney failure.