A Case of Ischemic Monomelic Neuropathy after Arteriovenous Fistula Placement

Authors

Vikram Sangani, Hospitalist, Department of Internal Medicine, Mercy Clinic, 621 S. New Ballas Road, suite 112A, St. Louis, Missouri- 63141Follow
Mytri Pokal, Hospitalist, Department of Internal Medicine, Mercy Clinic, 621 S. New Ballas Road, suite 112A, St. Louis, Missouri- 63141
Edva Noel, Nephrologist, Department of nephrology, Temple university hospital 3440 N. Broad Street Kresge West, Suite 100 Philadelphia,PA-19140
Narsimha Rao Keetha, Nephrologist, Department of Nephrology, Ohio kidney and hypertension center, 7255 Old oak Blvd, Suite C111, Cleveland,OH-44130
Sasmit Roy, Department of Internal Medicine, Centra Lynchburg General Hospital, 1901 Tate Springs Rd, Lynchburg,VA- 24501
Indrajeet Mahata, Assistant professor of Medicine, Mercy Hospital Springfield, 1235 E. Cherokee Street Springfield,MO 65804

Abstract

Ischemic monomelic neuropathy (IMN) is a relatively uncommon and under-recognized complication of vascular access creation for arteriovenous (AV) fistula in hemodialysis patients. They usually develop distal muscle weakness, sensation loss, and severe acute pain without muscle necrosis soon after AV fistula creation. Physicians should be aware of this condition as prompt diagnosis and timely vascular interventions are necessary to save the limbs and prevent permanent functional disability. Once the diagnosis of IMN is made, the patients will need emergent ligation of the fistula to restore the distal perfusion. We report a case of a 59-year-old male patient with End-stage Renal Disease on hemodialysis who developed severe pain, weakness, and loss of sensation in the left arm a few hours after left brachiocephalic vascular access creation. He was subsequently diagnosed with ischemic monomelic neuropathy and underwent emergent AV fistula ligation. Symptoms were relieved immediately after the ligation.

Recommended Citation

Sangani, Vikram; Pokal, Mytri; Noel, Edva; Keetha, Narsimha Rao; Roy, Sasmit; and Mahata, Indrajeet (2023) "A Case of Ischemic Monomelic Neuropathy after Arteriovenous Fistula Placement," Journal of Community Hospital Internal Medicine Perspectives: Vol. 13: Iss. 3, Article 22.
DOI: 10.55729/2000-9666.1200
Available at: https://scholarlycommons.gbmc.org/jchimp/vol13/iss3/22