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Surgical intervention for upper extremity nerve compression related to arteriovenous hemodialysis accesses.

动静脉血液透析相关上肢神经压迫的手术干预。

  • 影响因子:1.12
  • DOI:10.1177/1129729820922711
  • 作者列表:"Tordoir JH","van Loon MM","Zonnebeld N","Snoeijs M","van Nie F
  • 发表时间:2021-01-01
Abstract

OBJECTIVE:Chronic renal failure patients with arteriovenous hemodialysis access may exhibit pain and neurological complaints due to local nerve compression by the access conduit vessels of autogenous arteriovenous fistulas or the prosthesis of arteriovenous grafts. In this study, we have examined the results of surgical intervention for vascular access-related nerve compression in the upper extremity. METHODS:A single center retrospective study was performed of all patients referred for persistent pain and neurological complaints after vascular access surgery for hemodialysis. There were four brachial-cephalic, three brachial-basilic upper arm arteriovenous fistulas, and three prosthetic arteriovenous grafts. All patients had pain and sensory deficits in a distinct nerve territory (median nerve: 6; median + ulnar nerve: 1; medial cutaneous nerve: 1), and two patients had additional motor deficits (median nerve). RESULTS:A total of 10 patients (mean age: 59 years; range: 25-73 years; 2 men; 4 diabetics) were treated by surgical nerve release alone (2 patients) or in combination with access revision (8 patients). Mean follow-up was 23 months (range: 8-46 months). Direct complete relief of symptoms was achieved in six patients. Three patients had minor complaints, and one patient had a reoperation with good success. CONCLUSION:Vascular access-related nerve compression is an uncommon cause for pain, sensory and motor deficits after vascular access surgery. Surgical nerve release and access revision have good clinical outcome with relief of symptoms and maintenance of the access site in the majority of patients.

摘要

目的: 慢性肾衰竭患者动静脉血液透析通路可能由于自体动静脉瘘通路血管或动静脉移植物假体的局部神经压迫而表现出疼痛和神经系统不适。在这项研究中,我们检查了上肢血管通路相关神经卡压的手术干预结果。 方法: 对所有因血液透析血管通路手术后持续性疼痛和神经系统不适而转诊的患者进行单中心回顾性研究。有4个臂-头,3个臂-贵要上臂动静脉瘘和3个人工动静脉移植物。所有患者在不同的神经区域都有疼痛和感觉缺陷 (正中神经: 6; 正中 + 尺神经: 1; 内侧皮神经: 1),两名患者有额外的运动缺陷 (正中神经)。 结果: 共有10名患者 (平均年龄: 59岁; 范围: 25-73岁; 2名男性; 4名糖尿病患者) 通过单独手术神经松解术 (2名患者) 或与通路翻修术 (8名患者) 联合治疗。平均随访23个月 (范围: 8-46个月)。在6名患者中实现了症状的直接完全缓解。3例患者有轻微的主诉,1例患者再次手术成功。 结论: 血管通路相关神经卡压是血管通路手术后疼痛、感觉和运动障碍的不常见原因。手术神经松解和入路翻修具有良好的临床结果,在大多数患者中缓解症状并维持入路部位。

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