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Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients
BACKGROUND: The superficial runoff veins anatomically run alongside the cutaneous nerves in the volar forearm. Consequently, the surgical repair of vascular access (VA)-associated venous aneurysms attached to the cutaneous nerves could cause intraoperative nerve injury. Therefore, we proposed a cuta...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641029/ https://www.ncbi.nlm.nih.gov/pubmed/32985325 http://dx.doi.org/10.1177/1129729820959927 |
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author | Matsuda, Hiroaki Oka, Yoshinari Yoshida, Ryuichi Takatsu, Shigeko Miyazaki, Masashi |
author_facet | Matsuda, Hiroaki Oka, Yoshinari Yoshida, Ryuichi Takatsu, Shigeko Miyazaki, Masashi |
author_sort | Matsuda, Hiroaki |
collection | PubMed |
description | BACKGROUND: The superficial runoff veins anatomically run alongside the cutaneous nerves in the volar forearm. Consequently, the surgical repair of vascular access (VA)-associated venous aneurysms attached to the cutaneous nerves could cause intraoperative nerve injury. Therefore, we proposed a cutaneous nerve-conscious VA-related aneurysmal repair assisted by nerve ultrasonography. This ultrasonography aids in the preoperative examination of the courses of the nerves neighboring the aneurysm. METHODS: Sixteen consecutive patients who underwent surgical revisions of VA-related aneurysms (14 venous aneurysms and two arterial pseudoaneurysms) were enrolled. The locations of aneurysms derived from preexisting arteriovenous fistulas included 11 radiocephalic arteriovenous fistulas in the wrist or distally, three radiocephalic arteriovenous fistulas at the antecubital fossa, and two brachiocephalic arteriovenous fistulas at the antecubital fossa or in the distal upper arm. A preoperative ultrasonographic scan of the cutaneous nerve trunks that ran peripherally toward and along the aneurysms was attempted to avoid nerve injuries during operations. Basically, the aneurysms were resected from the proximal to the distal ends after being separated from the preserved adjacent nerves. RESULTS: The cutaneous nerve trunks that coursed toward and along the aneurysm could be identified by preoperative ultrasonography and could be preserved intraoperatively based on ultrasonographic findings in all patients. In four patients, the cutaneous nerve branch was unexpectedly or intentionally severed for a seamless surgical process because the nerve branch that divided from the cutaneous nerve trunk was strongly attached to the aneurysm. They subsequently suffered from hypoesthesia, but did not experience neuropathic pain. CONCLUSION: Preoperative ultrasonographic examination of the cutaneous nerve facilitated the intraoperative prevention of cutaneous nerve injury in VA-related aneurysmectomy. Nerve-sparing VA surgery assisted by preoperative nerve ultrasonography based on the understanding of topological anatomy might contribute to the reduction in postoperative neuropathy and enhance comfort in the daily life of hemodialysis patients. |
format | Online Article Text |
id | pubmed-8641029 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-86410292021-12-04 Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients Matsuda, Hiroaki Oka, Yoshinari Yoshida, Ryuichi Takatsu, Shigeko Miyazaki, Masashi J Vasc Access Original Research Articles BACKGROUND: The superficial runoff veins anatomically run alongside the cutaneous nerves in the volar forearm. Consequently, the surgical repair of vascular access (VA)-associated venous aneurysms attached to the cutaneous nerves could cause intraoperative nerve injury. Therefore, we proposed a cutaneous nerve-conscious VA-related aneurysmal repair assisted by nerve ultrasonography. This ultrasonography aids in the preoperative examination of the courses of the nerves neighboring the aneurysm. METHODS: Sixteen consecutive patients who underwent surgical revisions of VA-related aneurysms (14 venous aneurysms and two arterial pseudoaneurysms) were enrolled. The locations of aneurysms derived from preexisting arteriovenous fistulas included 11 radiocephalic arteriovenous fistulas in the wrist or distally, three radiocephalic arteriovenous fistulas at the antecubital fossa, and two brachiocephalic arteriovenous fistulas at the antecubital fossa or in the distal upper arm. A preoperative ultrasonographic scan of the cutaneous nerve trunks that ran peripherally toward and along the aneurysms was attempted to avoid nerve injuries during operations. Basically, the aneurysms were resected from the proximal to the distal ends after being separated from the preserved adjacent nerves. RESULTS: The cutaneous nerve trunks that coursed toward and along the aneurysm could be identified by preoperative ultrasonography and could be preserved intraoperatively based on ultrasonographic findings in all patients. In four patients, the cutaneous nerve branch was unexpectedly or intentionally severed for a seamless surgical process because the nerve branch that divided from the cutaneous nerve trunk was strongly attached to the aneurysm. They subsequently suffered from hypoesthesia, but did not experience neuropathic pain. CONCLUSION: Preoperative ultrasonographic examination of the cutaneous nerve facilitated the intraoperative prevention of cutaneous nerve injury in VA-related aneurysmectomy. Nerve-sparing VA surgery assisted by preoperative nerve ultrasonography based on the understanding of topological anatomy might contribute to the reduction in postoperative neuropathy and enhance comfort in the daily life of hemodialysis patients. SAGE Publications 2020-09-28 2021-11 /pmc/articles/PMC8641029/ /pubmed/32985325 http://dx.doi.org/10.1177/1129729820959927 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Articles Matsuda, Hiroaki Oka, Yoshinari Yoshida, Ryuichi Takatsu, Shigeko Miyazaki, Masashi Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients |
title | Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients |
title_full | Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients |
title_fullStr | Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients |
title_full_unstemmed | Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients |
title_short | Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients |
title_sort | cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641029/ https://www.ncbi.nlm.nih.gov/pubmed/32985325 http://dx.doi.org/10.1177/1129729820959927 |
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