Hemorrhage of AV fistula

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 US studies can identify the aneurysm or pseudoaneurysm

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

Diagnosis

• Consider Doppler US

Management

• Control bleeding w/ 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
  • Protamine sulfate for severe Unfractionated heparin reversal
  • DDAVP for Uremic bleeding syndrome
• Topical thrombin
• QuikClot or similar product application
• Purse string suture
• If can not be stopped with above measures, place upper extremity tourinquet and consult vascular surgeon vs IR.

See Also

• Dialysis complications