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
- 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