Program Book - Keck School of Medicine of USC - University of ...

Physical Exam of AVF• Has an accuracy of 80% in predicting maturation(Robbin M. Radiology 2002)• Normal mature AVF– easily compressible– soft pulse that quickly augments with AVF compression– prominent thrill at the anastomosis during systole anddiastole, thrill often extends over long segment of AVFPhysical Exam of AVF• Visible superficial branches– Accessory veins• Thrill that persists despite AVF occlusion– Significant upstream accessory veins• Enlarging segment near the anastomosis– Downstream venous stenosis• Weak pulse and weak thrill– Poor inflow due to arterial or anastomotic stenosis• Strong, abrupt pulse. Thrill absent or limited to systole.– Good arterial inflow and significant venous stenosis• Bounding pulse at the anastomosis. Pulse disappears within 5 cmdowstream.– Juxta-anastomotic stenosis• Contour of AVF hard to discern. Weak thrill.– AVF may be too deep• Arm swelling– Central venous stenosisAnatomical Derangements Responsiblefor AVF Non-maturation• Accessory veins• Arterial inflow stenosis• Arterial anastomotic stenosis• Juxta-arterial anastomosis stenosis• Venous stenosis in body/outflow tract of AVF• Central venous stenosis• Deep or excessively tortuous AVF90