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Clotting of AV fistula
From WikEM
Contents
Background
- AV shunt/fistula for dialysis
- Most common causes of inadequate dialysis flow
- Loss of bruit and thrill over access
Clinical Features
- Hard clot palpated in normally soft AV shunt
- Lessened or absent thrill
Differential Diagnosis
AV Fistula Complications
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
Evaluation
- Consider ultrasound of AV shunt
- CBC
- Chem 7
- PT/PTT
Management
- Stenosis and even thrombosis are not emergencies, but must be intervened on within 48 hours[1]
- Consider discussing with vascular surgeon that placed AV shunt
- Consult Interventional Radiology for clot thrombolysis
- Can be treated within 24hr by angiographic clot removal or angioplasty
- Thrombosis of vascular access can be treated with direct injection of alteplase 2.2mg
Disposition
- Home, if resolved
See Also
External Links
References
- ↑ Tordoir J, et al. 7. Treatment of stenosis and thrombosis in AV fistulae and AV grafts. EBPG on Vascular Access. ii103-ii106.
Authors
Ross Donaldson, Neil Young, Kevin Lu, Claire, Babak Missaghi, Daniel Ostermayer
