Hemorrhage of AV fistula


  • Potentially life-threatening
  • Can result from aneurysms, anastomosis rupture, or over-anticoagulation


  • Aneursym (true)
    • Most are asymptomatic; rarely rupture
  • Pseudoaneurysm
    • Results from subcutaneous extravasation of blood from puncture sites
    • Bleeding from puncture site is usually controlled by digital pressure or subq suture (if placed deep will often ruin shunt)
    • Consider vascular surgery consultation for continued bleeding or infection
    • Arterial Doppler ultrasound studies can identify the aneurysm or pseudoaneurysm

Clinical Features

Differential Diagnosis

AV Fistula Complications


  • Consider Doppler US


Purse string.jpg
  • Figure-of-8 stitch with 3-0 nylon or 5-0 prolene
  • Can attempt desmopressin acetate 0.3 mcg/kg IV[2]
  • If can not be stopped with above measures, place upper extremity tourniquet and consult vascular surgeon vs IR.


  • Consider discharge if hemodynamically stable with minimal blood loss

See Also

External Links



  1. Vesely TM. Use of a Purse String Suture to Close a Percutaneous Access Site After Hemodialysis Graft Interventions. JVIR 1998; 9:447-450. http://www.vascularaccessdoc.com/pdf/22.pdf.
  2. Calvert JH, Cline DM. End-stage renal disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York, NY: McGraw-Hill; 2020:(Ch) 90.