Clotting of AV fistula

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

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


References
  1. Tordoir J, et al. 7. Treatment of stenosis and thrombosis in AV fistulae and AV grafts. EBPG on Vascular Access. ii103-ii106.
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