View source for 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 shunt complications DDX}}

==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<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
*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==
*[[Hyperkalemia]]
*[[Dialysis complications]]

==External Links==


==References==
<references/>

[[Category:Renal]]
[[Category:Vascular]]