Hemorrhage of AV fistula

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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

AV Fistula Complications

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
  • Topical thrombin
  • QuikClot or similar product application
  • Purse string suture with 3-0 nylon suture[1]
Purse string.jpg
  • If can not be stopped with above measures, place upper extremity tourinquet and consult vascular surgeon vs IR.

Disposition

  • Consider discharge if hemodynamically stable with minimal blood loss

See Also

External Links

References

  1. 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.