Progress in Diagnosis and Treatment of Limb Pain in Hemodialysis Patients With an Arteriovenous Fistula.

Abstract

In hemodialysis patients being dialyzed using an arteriovenous fistula, limb pain is a common problem with multifactorial etiologies, including puncture pain, dialysis access-associated ischemic steal syndrome, ischemic monomelic neuropathy, carpal tunnel syndrome, complex regional pain syndrome, and axillary artery dissection. The common causes of limb pain related to vascular access include direct puncture pain, vascular complications (such as stenosis, thrombosis, aneurysm), and nerve injury. The puncture pain related to dialysis access can be alleviated by local anesthetics (such as lidocaine gel), cryotherapy, and advanced catheter techniques (such as button hole method). The ischemic steal syndrome related to dialysis access requires surgical intervention. Common surgical methods include ligation or vascular reconstruction. Emergency ligation of the fistula is a common surgical approach for ischemic single nerve lesion. For carpal tunnel syndrome, surgical release or wearing a brace is needed to improve the condition. For complex regional pain syndrome, multimodal analgesia and sympathetic nerve block are required. The main treatment method for axillary artery dissection is vascular stent implantation. Early detection, early diagnosis, and early treatment are crucial for maintaining vascular access function and improving patient prognosis.