A Persistent Median Artery Causing Carpal Tunnel Syndrome in a Patient with Chronic Renal Failure: Case Report

A 63-year-old woman presented with carpal tunnel syndrome 6 years after being diagnosed as having chronic renal failure and 1 year after the start of hemodialysis treatment. Symptoms were in the hand contralateral to the side of the arteriovenous fistula used for hemodialysis. During surgery, a large, patent, noncalcified median artery was found pulsating in the carpal tunnel; this pulsation was causing the compression of the median nerve. The flexor retinaculum was decompressed, and the median artery was transposed. This is the first reported case of a persistent median artery in a hemodialysis patient who has symptoms contralateral to the vascular access. The pathophysiology and epidemiology of carpal tunnel syndrome in chronic renal failure patients is reviewed. In addition, the role of the median artery in the vascularization of the hand and the management of a persistent median artery causing carpal tunnel syndrome are reviewed.