Overview of hemodialysis arteriovenous fistula maintenance and thrombosis prevention
- Michael Allon, MD
Michael Allon, MD
- Professor of Medicine
- University of Alabama at Birmingham
- Section Editors
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
- David L Cull, MD
David L Cull, MD
- Section Editor — Arterial and Venous Access
- Clinical Professor, Department of Surgery
- University of South Carolina School of Medicine
This topic provides an overview of general issues regarding arteriovenous (AV) fistula maintenance, including measures to prevent AV fistula thrombosis and management of the high-risk fistula. These same considerations with respect to AV grafts are reviewed separately. (See "Overview of hemodialysis arteriovenous graft maintenance and thrombosis prevention".)
RISK FACTORS FOR AV FISTULA THROMBOSIS
Many factors influence the choice of type and location for AV fistula creation and should be taken into account during patient selection and surgical creation of the fistula. Although some of these factors affect outcomes, once the access has been placed, they cannot generally be modified. (See "Overview of chronic hemodialysis vascular access".)
Other factors that can lead to AV fistula dysfunction and thrombosis include:
●Pre-existing stenotic lesions
●Cannulation injury/more frequent cannulation (ie, daily hemodialysis)
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- RISK FACTORS FOR AV FISTULA THROMBOSIS
- ROUTINE FISTULA MAINTENANCE AND CARE
- Cannulation and decannulation
- - Inspection prior to initial cannulation
- - Standard versus buttonhole technique
- - General procedure
- - Cannulating a fistula
- - Decannulating a fistula
- - Cannulation difficulty or failure
- Care between dialysis sessions
- HIGH-RISK AV FISTULAS
- Nonmaturing AV fistula
- Venous stenotic lesions
- Thrombosis without identified stenotic lesion
- AV fistula with aneurysm
- Secondary AV fistula
- INEFFECTIVE AND INVESTIGATIONAL THERAPIES
- Antithrombotic therapies
- Fish oil
- Phosphodiesterase inhibitors
- SUMMARY AND RECOMMENDATIONS