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Complications

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

An arteriovenous fistula (AVF) may give rise to the following complications:

  • infection
    • responsible for 20%of all AVF related complications
    • the severity may vary from localised cellulitis (erythema and heat) to abscess formation (fluctuance and tenderness) and bacteraemia (pyrexia, rigors, and feeling unwell)
    • screen patients using microbiological swabs and serum samples for
      • meticillin resistant Staphyloccocus aureus
      • vancomycin resistant enterococci
      • extended spectrum β lactamase producing organisms
    • if AVF becomes the source of recurrent septic emboli, surgical closure may be required
  • thrombosis
    • can be due to pre-existing or acquired anatomical lesions, stenosis, hypercoagulability, and compression of the fistula.
    • antiplatelets may be beneficial during the early postoperative period (when the risk of thrombosis is high)
  • stenosis
    • stenosis describes the narrowing of the lumen for more than 50% and is the most common cause of late failure of fistulas
    • if caused during the first month of creating the AVF, technical error is the usual cause
    • assess for evidence of stenosis (can be carried out in the clinic or by the patient at home)
      • have the fistula arm dependent with the fist close
      • observe for the filling of the vein
      • slowly raise the arm – the AVF should collapse in the absence of a stenosis
      • if a section of the AVF has not collapsed, the stenosis lies at the junction
    • preferred treatment of choice is percutaneous angioplasty
  • aneurysm
    • may occur as a natural process with time due to increase in blood flow
    • evidence of overlying skin changes and ulceration (indicates increased risk of rupture and severe haemorrhage) may warrant surgical repair
  • ischaemic polyneuropathy
    • patient may present with paraesthesia, dysaesthesia, severe pain, and muscle weakness
    • more common in pre-existing diabetes and peripheral vascular disease (when AVF is created using brachial artery)
  • Steal syndrome
    • seen in 8% of the patients receiving haemodyalisis but the rate increases to 75-90% in elderly patients, patients with diabetes and peripheral vascular disease
    • patients may present with
      • considerable pain
      • a cold hand, and discoloration of the skin due to relative hypoperfusion of the extremity
      • weak or absent pulse
      • with time neuropathic features may develop resulting in a typical “claw hand” contracture.
  • high output cardiac failure
    • caused by shunting of arterial blood from the left to right sided circulation
    • cardiac output is estimated to be increased by 15% and end diastolic ventricular pressure by 4%
    • risk of developing high output cardiac failure is higher when the AVF is proximal
    • patients will have typical cardiac failure symptoms - dyspnoea and peripheral oedema
  • limb hypertrophy in children - result from congenital fistulae. The whole of the limb is increased in length and volume, with the skin warmer and pinker than the normal side

Reference:


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