A hemodialysis patient who developed convulsive seizures following arteriovenous graft implantation : the considerable impact of dialysis shunts on organ blood flow

Abstract

Dialysis partients with arteriovenous shunts occasionally develop organ disorders. Although cardiac overload has often been reported in such cases, only a limited number of studies have described cases in which central nervous system lesions arose in dialysis patients with arteriovenous shunts. Herein, we report a case in which a 70-year-old female presented with absence and convulsion seizures during hemodialysis shortly after the implantation of a synthetic graft. Maintenance dialysis therapy was initiated due to diabetic renal failure, initially via a shunt created from the patient’s native vessels. However, a second surgical graft procedure was eventually required a couple of months later in order to increase the shunt flow rate because severe calcification was detected in the radial artery. Although the patient did not have a history of stroke despite exhibiting various vascular risk factors, including diabetes mellitus, hypertension, and dyslipidemia, radiological images clearly showed occlusion of the bilateral internal jugular and vertebral arteries, whereas there were few significant abnormalities in the cerebral parenchyma. On the presumption that hemodialysis via the arteriovenous graft had resulted in blood being diverted away from the brain, surgical occlusion of the shunt was performed. Afterward, a central venous catheter was used as a substitute for a vascular access port. As expected, no neurological symptoms were experienced, reflecting the marked improvement in cerebral blood flow demonstrated on ¹²³I-iodoamphetamine perfusion scintigraphy. Interestingly, the patient’s shunt flow was not very high (346 mL/min), which disagrees with the findings of previously-reported cases of shunt-related cerebral involvement. Our findings indicate that when clinicians are selecting a vascular access method for dialysis, both generalized vascular pathologies and the state of the anastomotic vessels should be taken into consideration. The present case might provide a deep insight into surgery for dialysis shunts.