Mehmet KIZILAY, Abdinafic Mohamud HUSSEIN, Bektaş KORKMAZ

Does arteriovenous fistula operation cause neuropathy in upper extremity? An EMG study

Aim: Neuron function is impaired in uremic patients and peripheral neuropathy occurs in 60-80% of patients with end-stage renal disease. However, the effects of arteriovenous fistula intervention on the nerve functions in those are uncertain. The purpose of this study is to weigh the effects of arteriovenous fistula intervention on the nerve functions by using electromyography among patients who have end-stage renal disease. Materials and Methods : Forty-three renal insufficiency patients on dialysis, living in Somalia, who had undergone arteriovenous fistula operation, were included in the present prospective study. Demographic characteristics were recorded. The electromyographic measures (both motor and sensorial) of median, ulnar, radial nerve on the operated side arm were assessed. Tibial, peroneal and sural nerve electromyographic measures were also evaluated. After the arteriovenous fistula operation, the electromyographic measures were again assessed to determine the effects of arteriovenous fistula intervention on the nerve functions. Results: The mean age of patients was 56±17 years and 56.3% of them were male. 88% of the recruited patients underwent radiocephalic fistula operation while in the remaining 12% type of the fistula was brachiocephalic. Between the pre and the post-operative electromyographic measures, there were not any significant changes except tibial nerve motor distal latency. The mean tibial nerve motor distal latency decreased with operation from 6.59±1.39 ms to 6.17±1.18 ms (p =0.038). Upper extremity motor and sensory nerve amplitudes, except ulnar sensory nerve amplitude, were found to have a non-significant decrease trend after surgery. Lower extremity motor and sensory nerve amplitudes nonsignificantly increased after surgery. Conclusions: This is the first prospective study to investigate the relationship of nerve functions with arteriovenous fistula operation by monitoring the electromyographic measures among end-stage renal disease patients. The present results demonstrated that arteriovenous fistula operation did not have unfavorable effects on nerve functions in the adjacent operation side. Further studies are needed with a larger sample size to verify this issue.

PDF

___

1. Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg. 2004;107(1):1–16.
2. Dyck PJ, Johnson WJ, Lambert EH, O’Brien PC. Segmental demyelination secondary to axonal degeneration in uremic neuropathy. Mayo Clin Proc. 1971;46(6):400–431.
3. Fraser CL, Arieff AI. Nervous system complications in uremia. Ann Intern Med. 1988;109(2):143–153.
4. Nielsen VK, Winkel P. The peripheral nerve function in chronic renal failure. 3. A multivariate statistical analysis of factors presumed to affect the development of clinical neuropathy. Acta Med Scand. 1971;190(1-2):119–125.
5. Lu W, Ren C, Han X, Yang X, Cao Y, Huang B. The protective effect of different dialysis types on residual renal function in patients with maintenance hemodialysis: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(37):e12325.
6. Ekim H, Kutay V, Akbayrak H, Basel H, Demir I, Hazar A, Karadağ M, Yakut C. Upper extremity distal ischemia complicating arteriovenous fistula. Turk J Vasc Surg 2006; 15: 025-030.
7. Gibbons CP. Neurological complications of vascular access. J Vasc Access. 2015;16 Suppl 9:S73–S77.
8. Tordoir JH, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg. 2004;27(1):1–5.
9. Siao P, Kaku M. A Clinician’s Approach to Peripheral Neuropathy. Semin Neurol. 2019;39(5):519–530.
10. Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician. 2010;81(7):887–892.
11. Tankisi H, Pugdahl K, Beniczky S, Andersen H, FuglsangFrederiksen A. Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis. Clin Neurophysiol Pract. 2019;4:214–222. Published 2019 Nov 18.
12. Hughes RA. Peripheral neuropathy. BMJ. 2002;324(7335):466–469.
13. Ogura T, Makinodan A, Kubo T, Hayashida T, Hirasawa Y. Electrophysiological course of uraemic neuropathy in haemodialysis patients. Postgrad Med J. 2001;77(909):451–454.
14. Mansouri B, Adybeig B, Rayegani M, Yasami S, Behshad V. Uremic neuropathy and the analysis of electrophysiological changes. Electromyogr Clin Neurophysiol. 2001;41(2):107–115.
15. Leone M, Bottacchi E, Alloatti S, Nebiolo PE, Aimino M, Baldini S. Follow-up of nerve conduction in chronic uremic patients during hemodialysis. Ital J Neurol Sci. 1992;13(4):317–321.
16. Jebsen RH, Tenckhoff H, Honet JC. Natural history of uremic polyneuropathy and effects of dialysis. N Engl J Med. 1967;277(7):327–333. doi:10.1056/NEJM196708172770702
17. Chen S, Andary M, Buschbacher R, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve. 2016;54(3):371–377.
18. Krishna, Garg (2010). "8 - Arm". BD Chaurasia’s Human Anatomy (Regional and Applied Dissection and Clinical) Volume 1 - Upper limb and thorax (5th ed.). India: CBS Publishers and Distributors Pvt Ltd. pp. 95, 111, 122, 128.
19. Brittinger WD. Angiologische und neurologische Probleme nach Hämodialyse-Shuntanlage am Arm [Angiological and neurological problems after shunt surgery in haemodialysis patients]. Handchir Mikrochir Plast Chir. 2005;37(3):167–175.
20. Gray’s anatomy : the anatomical basis of clinical practice. Standring, Susan (Forty-first ed.). [Philadelphia]. 2016.