Peripheral nerve compression by brachial artery-basilic vein vascular access in long-term hemodialysis

This report presents the first description of direct peripheral nerve compression as a complication of brachial artery-basilic vein vascular access in patients with uremia who are receiving long-term hemodialysis. Three patients are presented. An expanding basilic vein hematoma compressed the radial nerve in one patient. A graft associated abscess adjacent to the brachial artery compressed the median nerve in a second patient. A basilic vein aneurysm compressed the median nerve in a third patient. In two cases, electrodiagnostic studies were helpful in identifying the location and severity of the peripheral nerve dysfunction, and in excluding more common distal nerve dysfunction, which is sometimes seen in these patients as a result of circulatory alterations in the extremity caused by dialysis. Prompt surgical decompression led to significant recovery of nerve function in all three patients. It is concluded that direct peripheral nerve compression is a rare complication of brachial artery-basilic vein vascular access in patients with uremia who are receiving long-term hemodialysis.