Neurological complications from brachial arteriovenous fistulae.

A 69-year-old male cardiac transplant recipient with end-stage renal disease secondary to cyclosporin toxicity, presented with a painful swollen right brachial AVF following difficult cannulations over several consecutive dialysis sessions. On inspection there was a tender soft tissue swelling overlying the fistula, but a thrill was still palpable. Neurological examination revealed weakness of the muscles supplied by the terminal motor branch of the median nerve, with loss of sensation over the distribution of the terminal sensory branch. A duplex Doppler study demonstrated a pseudoaneurysm of the brachial artery surrounded by haematoma. In view of ongoing pain and progressive neurological signs the patient underwent emergency exploration of the AVF under general anaesthesia. A large haematoma was identified deep to the fascia and evacuated. The AVF was tied off and the patient underwent an uncomplicated post-operative recovery, with partial recovery of median nerve sensory and motor function. Dialysis continued via a tunnelled percutaneous internal jugular vascular catheter. Case 2