Hypotension and closure of hemodialysis access shunts

Two patients with chronic renal failure are presented who experienced thrombosis of an arteriovenous fistula not being used for hemodialysis at the time of occlusion. Preoperative subcutaneous heparin or intravenous dextran infusion, along with higher fluid allowances are recommended preventive considerations. Avoidance of malpositioning of the shunt extremity, intravenous infusion, and sphygmomanometry in the extremity with the fistula, are also advisable. The etiologic role of hypotension and low flow, whether as a complication of hemodialysis via another route, or resulting from unrelated surgery, is stressed.