Submission Deadline
20 Jun 2024 (Vol 47 , Iss 06 )

Upcoming Publication
31 May 2024 (Vol 47 , Iss 05 )

Journal ID : TMJ-06-12-2021-10853
Download [This article belongs to Volume - 44, Issue - 06]
Total View : 389

Title : Presentation and management of limb dysfunction after native hemodialysis arteriovenous fistula

Abstract :

Limb dysfunction following fistula creation can range from simple temporary finger numbness to even frank gangrene necessitating amputation. The etiologies of limb dysfunction related to native arteriovenous fistula (AVF) include venous hypertension, steal syndrome, symptomatic aneurysm, carpal tunnel syndrome, painful shoulder, ischemic monomelic neuropathy (IMN), and temporary neuropathy. A retrospective analysis of data was collected over four years (from January 2017 till May 2021) of 1709 patients who presented with vascular access-related complaints 176 of them had limb dysfunction after native hemodialysis arteriovenous fistula. All patients were assessed by history and physical exam, while investigations were done according to provisional diagnosis. The patient's information, management, and results were documented. The shortened disabilities of the arm, shoulder, and hand questionnaire (QuickDASH) was used in all included patients to assess the degree of disability. The most common cause of limb dysfunction was venous hypertension (27.04 %), followed by steal syndrome 26.7 %, symptomatic aneurysm 25.56 %, and carpal tunnel syndrome 7.95 %. The mean age of patients with the painful shoulder was higher than other etiologies, while the patients with venous hypertension were the youngest, with more females in the group. Patients with IMN and steal syndrome had the highest QuickDASH score and suffered the most intense pain of all participants. The surgical intervention was done in 133 patients. AVF preserving interventions relieved symptoms in 68.57 % of cases less than AVF sacrificing interventions which were effective in 83.07 % of cases, and the difference was statistically significant (p-value = 0.00072). We had one case of hand loss, two cases of fingertip loss, and one patient died after revascularization for steal syndrome. Limb dysfunction after native hemodialysis arteriovenous fistula is a common problem. AVF preserving intervention had a success rate and should be used in most cases before closing the AVF.

Full article