Arteriovenous fistula

238 Arteriovenous fistula



Instruction


Look at this patient’s arms.



Salient features



History




• History of trauma to the limb


• History of haemodialysis and artificial arteriovenous fistula.



Examination




• Hypertrophy of the affected arm


• Prominent, dilated, tortuous veins


• Continuous thrill over the fistula; listen for continuous bruit


• Collapsing pulse; increased pulse pressure indicating hyperdynamic circulation.


Proceed as follows:



• Look for signs of cardiac failure.


• Elicit Branham’s sign: slowing of the pulse on occluding the feeding vessel of the fistula.


• If the fistula is in the upper limb, then perform Allen’s test: the radial and ulnar arteries are occluded at the wrist and the hand is exercised; the arteries are then released one at a time to establish which is the dominant feeding vessel.


• Look for signs of chronic renal failure.


Note: An arteriovenous fistula is a direct subcutaneous anastomosis of an artery and vein without prosthetic material, and is the preferred means of vascular access for haemodialysis.



Diagnosis


This patient has an arteriovenous fistula (lesion) that has been surgically created (aetiology) for haemodialysis and is functioning well.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Arteriovenous fistula

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