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== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{AV shunt complications DDX}} | |||
==Workup== | ==Workup== | ||
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==Management== | ==Management== | ||
*Consider discussing with vascular | *Stenosis and even thrombosis are not emergencies | ||
*Consider discussing with vascular surgeon that placed AV shunt | |||
*Consult Interventional Radiology for clot thrombolysis | *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== | ==Disposition== | ||
*Home, if resolved | |||
==See Also== | ==See Also== | ||
Revision as of 06:06, 12 December 2014
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