Clotting of AV fistula


  • 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 Fistula Complications



  • Stenosis and even thrombosis are not emergencies, but must be intervened on within 48 hours[1]
  • 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


  • Home, if resolved

See Also

External Links


  1. Tordoir J, et al. 7. Treatment of stenosis and thrombosis in AV fistulae and AV grafts. EBPG on Vascular Access. ii103-ii106.