[Circulatory repercussions of arteriovenous fistulae at the carpal tunnel level].
From a series of 84 cases of arterio-venous fistula, created for regular haemodialysis in end-stage chronic renal failure patients, the authors observed only one case of median nerve pathology at the level of the carpal tunnel. They propose three aetiologies: segmental ischaemia of the median nerve from perfusional redistribution, a mononeuritis syndrome aggravated by ischaemia and extrinsic compression of the median nerve by oedema secondary to distal venous reflux following creation of the vascular anastomosis. The authors recommend a termino-lateral anastomosis of a superficial vein (the superficial radial or the cephalic) with the radial artery. Using this approach, they did not observe any distal oedema nor any venous reflux into the hand. When a carpal tunnel syndrome is discovered in a case of arterio-venous fistula, the patient needs to be investigated for venous reflux into the hand and needs fistulography to exclude aspiration of blood from the cubital artery by the palmar arcade.
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002349:Carpal Tunnel Syndrome / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008475:Median Nerve / Q000098:blood supply*; D006435:Renal Dialysis
Les répercussions circulatoires au niveau du tunnel carpien des fistules artério-veineuses.