Asploro Journal of Biomedical and Clinical Case Reports

Asploro Journal of Biomedical and Clinical Case Reports

Kaczynski RE^1*, Asaad Y¹, Valentin-Capeles N¹, Battista J^1
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

Abstract

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 4^th and 5^th 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.