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AV fistula outflow stenosis — ESENeph MCQ

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ModerateDialysisAV fistula outflow stenosisESENeph

A 63-year-old woman has rising venous pressures during haemodialysis and prolonged bleeding after needle withdrawal. Her brachiocephalic fistula remains pulsatile after compression and dialysis adequacy has fallen. Duplex ultrasound shows outflow stenosis. What is the most appropriate management?

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Correct answer: C — Refer for fistuloplasty of access stenosis

High venous pressures, prolonged post-needle bleeding and falling adequacy suggest access outflow stenosis, usually managed with imaging and angioplasty or surgical revision. Ligation sacrifices access and is not first-line unless severe complications exist. Anticoagulation does not correct a fixed stenosis and increases bleeding risk. The pearl is that surveillance of access function prevents thrombosis and loss of vascular access.

Reference: UKKA Vascular Access for Haemodialysis Guideline