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AV Fistula Thrombosis — RACP Adult Medicine MCQ

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ModerateNephrologyAV Fistula ThrombosisRACP Adult Medicine

A 58-year-old man on chronic haemodialysis via AV fistula develops sudden onset swelling and pain in his fistula arm. There is no thrill or bruit palpable. Doppler ultrasound shows thrombosis of the AV fistula. What is the most appropriate urgent management?

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Correct answer: E — Surgical thrombectomy or endovascular thrombolysis

Thrombosed AV fistula is a dialysis access emergency – without prompt intervention, the fistula may be permanently lost. Urgent surgical thrombectomy or interventional radiological thrombolysis/thrombectomy (catheter-directed urokinase or tPA, or mechanical thrombectomy) should be performed within 24–48 hours. Delay beyond 48 hours significantly reduces salvage rates. Meanwhile, temporary dialysis access (CVC) may be needed if the patient requires urgent dialysis. An underlying cause (stenosis, hypotension, hypercoagulability) should be identified and treated.

Reference: KHA-CARI – 2013 – Vascular Access Guidelines; eTG – 2025 – Nephrology