Arteriovenous Fistula Management Guidelines

Routine Monitoring Strategy

The Kidney Disease Outcomes Quality Initiative (KDOQI) recommends routine physical examination monitoring over surveillance testing, with intervention reserved for stenosis >50% accompanied by clinical dysfunction, focusing on maintaining functional, complication-free access while preserving future access sites 1, 2
Physical examination should be performed at every dialysis session using the "Look-Listen-Feel" approach rather than relying on expensive surveillance equipment 1, 2

High-risk clinical indicators, such as ipsilateral extremity edema persisting beyond 2 weeks post-creation, mandate immediate imaging and potential intervention 1, 3
Abnormal thrill, bruit, or pulse abnormalities require further evaluation 1, 2

Percutaneous transluminal angioplasty (PTA) or surgical revision is indicated when stenosis reaches >50% luminal diameter AND is associated with clinical/physiological abnormalities 3, 4
Inadequate flow to support prescribed dialysis blood flow, reduction in access flow with abnormal physical findings, or increased static pressures require intervention 3

Thrombectomy should be attempted as early as possible after detection, with endovascular interventions as first-line treatment and surgical thrombectomy reserved for endovascular failure 3, 4
Immediate AVF closure is mandatory for monomelic ischemic neuropathy, and emergent vascular surgery referral is required for severe symptomatic ischemia or tissue necrosis 5, 6
All AVF infections require 6 weeks of antibiotic therapy, and cannulation must cease at infected sites 3, 5
Imaging study is required to evaluate central vein patency for edema persisting beyond 2 weeks, and PTA is preferred treatment for central vein stenosis 5, 7
Surgical repair is indicated for aneurysms or pseudoaneurysms that are symptomatic, threaten skin viability, or have evidence of infection 7

Delaying evaluation of access dysfunction leads to thrombosis and access failure, and attempting cannulation through or near problematic sites exacerbates complications 4, 8
Failing to recognize early ischemia signs delays intervention, and underestimating the significance of minor drainage or swelling can lead to inadequate management of serious complications 3, 4, 8
Targeting thrombosis prevention in AVFs through aggressive intervention is counterproductive, as it does not improve AVF survival and may harm access longevity 9