Clotting of AV fistula: Difference between revisions
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{{AV shunt complications DDX}} | {{AV shunt complications DDX}} | ||
== | ==Evaluation== | ||
*Consider | *Consider [[ultrasound]] of AV shunt | ||
*CBC | *CBC | ||
*Chem 7 | *Chem 7 | ||
| Line 18: | Line 18: | ||
==Management== | ==Management== | ||
*Stenosis and even thrombosis are not emergencies, but must be intervened on within | *Stenosis and even thrombosis are not emergencies, but must be intervened on within 48 hours<ref>Tordoir J, et al. 7. Treatment of stenosis and thrombosis in AV fistulae and AV grafts. EBPG on Vascular Access. ii103-ii106.</ref> | ||
*Consider discussing with vascular surgeon that placed AV shunt | *Consider discussing with vascular surgeon that placed AV shunt | ||
*Consult Interventional Radiology for clot thrombolysis | *Consult Interventional Radiology for clot [[thrombolysis]] | ||
**Can be treated | **Can be treated within 24hr by angiographic clot removal or angioplasty | ||
**Thrombosis of vascular access can be treated | **Thrombosis of vascular access can be treated with direct injection of [[alteplase]] 2.2mg | ||
==Disposition== | ==Disposition== | ||
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==External Links== | ==External Links== | ||
==References== | |||
<references/> | <references/> | ||
[[Category: | [[Category:Renal]] | ||
[[Category:Vascular]] | [[Category:Vascular]] | ||
Latest revision as of 16:12, 16 October 2019
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.