Clotting of AV fistula: Difference between revisions
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==Background== | ==Background== | ||
*AV shunt/fistula for dialysis | *AV shunt/fistula for dialysis | ||
*Most common causes of inadequate dialysis flow | |||
**Loss of bruit and thrill over access | |||
==Clinical Features== | ==Clinical Features== | ||
*Hard clot palpated in normally soft AV shunt | *Hard clot palpated in normally soft AV shunt | ||
* | *Lessened or absent thrill | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{AV shunt complications DDX}} | |||
== | ==Evaluation== | ||
*Consider | *Consider [[ultrasound]] of AV shunt | ||
*CBC | *CBC | ||
*Chem 7 | *Chem 7 | ||
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==Management== | ==Management== | ||
*Consider discussing with vascular | *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> | ||
*Consult Interventional Radiology for clot thrombolysis | *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== | ==Disposition== | ||
*Home, if resolved | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
==References== | |||
<references/> | <references/> | ||
[[Category:Renal]] | |||
[[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.