Asploro Journal of Biomedical and Clinical Case Reports
Article Type: Case Report
Asp Biomed Clin Case Rep. 2020 Jul 04;3(2):147-50
Kaczynski RE1*, Asaad Y1, Valentin-Capeles N1, Battista J1
1Department of Surgery, St. John’s Episcopal Hospital, Far Rockaway, USA
Corresponding Author: Rachel E. Kaczynski
Address: Department of Surgery, St. John’s Episcopal Hospital, Far Rockaway, New York 11691, USA.
Received date: 09 June 2020; Accepted date: 26 June 2020; Published date: 04 July 2020
Citation: Kaczynski RE, Asaad Y, Valentin-Capeles N, Battista J. Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal. Asp Biomed Clin Case Rep. 2020 Jul 04;3(2):147-50.
Copyright © 2020 Kaczynski RE, Asaad Y, Valentin-Capeles N, Battista J. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Vascular Steal, Ischemic Monomelic Neuropathy, Arteriovenous, AV Fistula, Steal Syndrome
Abbreviations: IMN: Ischemic Monomelic Neuropathy, DRIL: Distal Revascularization Interval Ligation, PACU: Post-Anesthesia Care Unit
We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.