Hemorrhage of AV fistula
Background
- Potentially life-threatening
- Can result from aneurysms, anastomosis rupture, or over-anticoagulation
Types
- Aneursym (true)
- Most are asymptomatic; rarely rupture
- Pseudoaneurysm
- Results from subcutaneous extravasation of blood from puncture sites
- Bleeding from puncture site is usually controlled by digital pressure or subq suture (if placed deep will often ruin shunt)
- Consider vascular surgery consultation for continued bleeding or infection
- Arterial Doppler ultrasound studies can identify the aneurysm or pseudoaneurysm
Clinical Features
Differential Diagnosis
Evaluation
- Consider Doppler US
Management
- Control bleeding with pressure applied to puncture site for 5-10min; observe for 1-2hr
- Utilize fistula clamp to apply small focus of direct pressure
- Bulky dressing with allow for continued bleeding
- Correct coagulopathy
- Protamine sulfate for severe Unfractionated heparin reversal
- DDAVP for Uremic bleeding syndrome
- Topical thrombin
- QuikClot or similar product application
- Purse string suture with 3-0 nylon suture[1]
- If can not be stopped with above measures, place upper extremity tourniquet and consult vascular surgeon vs IR.
Disposition
- Consider discharge if hemodynamically stable with minimal blood loss
See Also
External Links
References
- Vesely TM. Use of a Purse String Suture to Close a Percutaneous Access Site After Hemodialysis Graft Interventions. JVIR 1998; 9:447-450. http://www.vascularaccessdoc.com/pdf/22.pdf.
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