Electrophysiologic study of upper extremity peripheral nerves following arteriovenous access creation in end stage renal disease patients

Abstract

Background and aims
Arteriovenous fistula (AVF) creation is a surgical procedure that involves connecting an artery and a vein, typically in the forearm or upper arm. This alteration in blood flow dynamics can indeed lead to nerve-related complications [1]. The aim of this work was to evaluate the electrophysiologic changes of peripheral nerves of the upper extremity after creation of AV access in end stage renal disease (ESRD) patients.


Methodology
This prospective study included 50 ESRD patients requiring upper limb AVF for hemodialysis. Electrophysiological evaluation was performed preoperatively and postoperatively to assess median, ulnar, and radial nerves for sensory and motor function, with parameters such as amplitude of compound muscle action potential, latency, and nerve conduction velocity being measured. Data were analyzed using IBM SPSS software package version 20.0, with statistical significance judged at the 5% level using Paired t-test for normally distributed quantitative variables and Wilcoxon signed ranks test for abnormally distributed quantitative variables.


Results

This prospective study included 50 ESRD patients requiring upper limb AVF for hemodialysis. Electrophysiological evaluation was performed preoperatively and postoperatively to assess median, ulnar, and radial nerves for sensory and motor function, with parameters such as amplitude of compound muscle action potential, latency, and nerve conduction velocity being measured. There was no statistically significant difference in sensory ulnar and radial nerve parameters after creation of the AVF. On the other hand, when comparing the motor parameters between the pre- and post-cases, a statistically significant decrease was observed in ulnar motor nerve amplitude ((
P
 = 0.025). Comparing sensory parameters in diabetic and non-diabetic patients with upper limb AVF, no statistically significant difference was found. However, there was a significant decrease in motor radial nerve amplitude observed within the diabetic group (
P
 = 0.006). Regardless of the type of AVF created, there was no statistically significant difference observed in any of the sensory nerve parameters measured. Conversely, the analysis reveals a statistically significant difference in motor ulnar nerve conduction velocity (CV) among the three shunt types (
p
 = 0.036).



Conclusions
Significant changes of motor ulnar nerve conduction parameters were observed indicating potential neurological impact of AVF. Diabetes mellitus (DM) had no significant effect on either sensory or motor conduction parameters except motor radial nerve amplitude. No significant difference of either sensory or motor conduction parameters in different types of AVF when compared to each other except a significant ulnar nerve motor change.