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
• Lessoned or abscent 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

Workup

• Consider US of AV shunt
• CBC
• Chem 7
• PT/PTT

Management

• Stenosis and even thrombosis are not emergencies
• Consider discussing with vascular surgeon that placed AV shunt
• Consult Interventional Radiology for clot thrombolysis
  • Can be treated w/in 24hr by angiographic clot removal or angioplasty
  • Thrombosis of vascular access can be treated w/ direct injection of alteplase 2.2mg

Disposition

• Home, if resolved

See Also

• Hyperkalemia
• Dialysis complications