Ischaemic Monomelic Neuropathy in a Diabetic Patient after Brachio-Basilic Arteriovenous Fistula Creation

Introduction: The number of people with diabetes is increasing in every country. Recent estimates put the prevalence at 8.3% of adults, with a predicted rise to 10.1 in 2035 [1]. Although less than 1% of patients with diabetes require definitive haemodialysis, this still represents a significant number who may require arteriovenous fistula creation. Presentation: We report a case of IMN occurring in a patient with end stage diabetic nephropathy following brachio-basilic arteriovenous fistula creation for chronic maintenance haemodialysis. Discussion: Ischaemicmonomelic neuropathy (IMN) has developed as a distinct clinical entity involving dysfunction of multiple peripheral nerves following vascular access. Symptom onset is usually immediate, and neurological symptoms are dominant, generally in the absence of significant clinical ischaemia. Acute neurological symptoms may be disabling and irreversible, but prompt ligation of arteriovenous fistula can prevent permanent disability. Conclusion: Ischaemicmonomelic neuropathy (IMN) is a rare but serious complication of vascular access for arteriovenous fistula for haemodialysis and should be considered in the differential diagnosis of hand dysfunction following such surgery. While the condition is not preventable or predictable, prompt recognition and treatment can lead to prevention of permanent disability.