Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with [ipsilateral/contralateral] AV fistula dysfunction, characterized by [swelling of the arm/face/neck, increased venous pressure during dialysis, prolonged bleeding post-cannulation, or pulsatile flow]. History significant for prior central venous catheter placement. No reported symptoms of superior vena cava syndrome.
Clinical Examination Findings
Physical examination reveals significant edema of the [ipsilateral] upper extremity, prominent collateral venous circulation over the chest wall or shoulder, and facial plethora. AV fistula assessment shows [high-pitched bruit, palpable thrill, or diminished flow]. No signs of infection or hematoma at the access site.
Treatment Protocol
Plan: Refer for diagnostic fistulogram and venography. If stenosis confirmed, proceed with percutaneous transluminal angioplasty (PTA) or stent placement. Monitor dialysis venous pressures closely. Consider surgical revision if endovascular intervention fails.