Ischemic Monomelic Neuropathy: A Long-Term follow-up of Two Cases

Singh, Vikas; Qaisar, Huzaif; Masud, Avais; Mehandru, Sushil; Sadiang-Abay, Elmer; Costanzo, Eric; Salman, Loay

doi:10.5301/jva.5000743

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…Although some reports showed that IMN hardly improved despite prompt ligation, 7 there are recent reports of recovery with conservative treatment alone. 10 As our cases recorded almost complete recovery although surgical ligation was delayed for over 20 days, the clinical course and prognosis of IMN may be more diverse than previously known. The first patient had long-standing diabetes and IMN occurred after AVF creation, while the second had no history of diabetes and IMN occurred after arteriovenous graft (AVG) creation.…”

Section: Discussionmentioning

confidence: 58%

Recovery from ischemic monomelic neuropathy after delayed ligation of dialysis access

2020

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Ischemic monomelic neuropathy is characterized by acute painful muscle weakness shortly after access creation and neuronal axon loss without adjacent tissue necrosis, thus, differentiating ischemic monomelic neuropathy from the steal syndrome. Immediate ligation of vascular access is emphasized in current guidelines. We present two cases of recovery from ischemic monomelic neuropathy despite delayed ligation for over 20 days after ischemic monomelic neuropathy development. The gradual change in serial nerve conduction studies over the 15-month follow-up after surgical ligation was noted along with clinical recovery. Our report indicates that the clinical course and prognosis of ischemic monomelic neuropathy may be more diverse than previously known.

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Section: Discussionmentioning

confidence: 58%

Recovery from ischemic monomelic neuropathy after delayed ligation of dialysis access

2020

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“…Ischemic monomelic neuropathy has been described in many case reports and narrative reviews. [63][64][65][66][67] It has been described as ischemia or infarction of the blood supply to the nerves (vasa nervosa) in the lower arm. 68 Ischemic monomelic neuropathy typically occurs immediately after the vascular access creation in the postoperative period.…”

Section: Ischemic Monomelic Neuropathymentioning

confidence: 99%

Vascular Access Emergencies in the Dialysis Patient

Sweat¹,

Clare²,

Evans³

2017

Emerg Med

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A ccording to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 468,000 persons in the United States are on dialysis-a number that continues to grow annually. 1 The 1-year rate for hemorrhagic complications from arteriovenous fistulas (AVFs) is estimated to be 0.4%. 2 One study by Ellingson et al 3 reported 1,654 deaths secondary to fatal vascular access hemorrhage over a 6-year period, accounting for 0.4% of all deaths of hemodialysis (HD) patients in that study. 3 Nonhemorrhagic vascular access-related complications also contribute to the morbidity and mortality associated with AVFs and arteriovenous grafts (AVGs). Venous stenosis resulting in thrombosis has been estimated to occur in 24.7% of AVGs and 9.0% of AVFs, both of which are common causes of access failure. Infection is reported to be the second leading cause of death in dialysis patients, and vascular access-related infection rates are reported to occur in 9.5% of AVGs vs 0.4% to 0.9% of AVFs. 2,4 Pseudoaneurysms and aneurysms range from 30% to 60% for AVFs, 2,5 and contribute to morbidity by limiting available areas to cannulate for dialysis, occasionally requiring surgical revision to restore access function or prevent access rupture. Steal phenomena, including dialysis access-induced steal syndrome (DASS) and ischemic monomelic neuropathy, as well as heart failure secondary to high output are additional contributors to morbidity and mortality. With the growing rate of end-stage renal disease (ESRD) in the United States and the contribution to morbidity and mortality by bleeding and other complications, it is essential to understand how to evaluate and treat these patients in the ED. This article reviews the evaluation and treatment of vascular access emergencies, as well as risk factors that contribute to complications in the ESRD patient population. The authors discuss evaluation and treatment of vascular access-related hemorrhage and nonhemorrhagic vascular access-related complications, along with the risk factors contributing to the increased bleeding in patients with end-stage renal disease.

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Vascular Steal

Beathard

2021

Dialysis Access Management

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Ischemic Monomelic Neuropathy: A Long-Term follow-up of Two Cases

Cited by 5 publications

References 6 publications

Recovery from ischemic monomelic neuropathy after delayed ligation of dialysis access

Recovery from ischemic monomelic neuropathy after delayed ligation of dialysis access

Vascular Access Emergencies in the Dialysis Patient

Vascular Steal

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