Approach to an Arteriovenous Access with Hyperpulsatile Pulse



A hyperpulsatile arteriovenous fistula (AVF) indicates a dialysis vascular access with a significant stenosis in the outflow segment. The physical examination performed with a hyperpulsatile AVF includes the arm elevation test, assessment of thrill in the segment distal to the stenosis, and listening to the pitch of the bruit over the entire outflow segment. A clinical finding of prolonged bleeding post withdrawal of dialysis needles is commonly encountered with hyperpulsatile AVF. The algorithm used in clinical practice for the appropriate management and role of percutaneous endovascular therapy for outflow stenosis is discussed in this chapter.


Arteriovenous Fistula Blood Pump Regular Dialysis Treatment Central Vein Stenosis Extracorporeal Dialysis 
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  1. 1.
    Asif A, Leon C, Orozco-Vargas LC, Krishnamurthy G, Choi KL, Mercado C, Merrill D, Thomas I, Salman L, Artikov S, et al. Accuracy of physical examination in the detection of arteriovenous fistula stenosis. Clin J Am Soc Nephrol. 2007;2(6):1191–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Abreo K, Allon M, Asif A, Atray N, Besarab A, Dember LM, Dixon BS, DeVita M, Kaufman J, Murray BM, et al. Which direction is right for vascular access surveillance? A debate. Nephrol News Issues. 2010;24(7):30, 32, 34.PubMedGoogle Scholar
  3. 3.
    Fistula First Breakthrough Initiative; 2013. Accessed on 26 Oct 2013.
  4. 4.
    Lee T, Roy-Chaudhury P. Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis. Adv Chronic Kidney Dis. 2009;16(5):329–38.PubMedCrossRefGoogle Scholar
  5. 5.
    Basile C, Lomonte C, Vernaglione L, Casucci F, Antonelli M, Losurdo N. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant. 2008;23(1):282.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Nephrology SectionW. G. (Bill) Hefner Veterans Affairs Medical CenterSalisburyUSA

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