Physical exam & stenosis of AV-Graft

Q: Which part of the hand is best to examine the "thrill" of an Arterio-venous graft (AVG) in hemodialysis (HD) patient?


Answer: Palm

A patent arteriovenous graft for HD patients should have a considerable thrill, which is best palpable with the palm. Although thrill should have both a systolic and a diastolic component, that's often hard to distinguish. It usually feels like a "soft, continuous, diffuse thrill." 

It is more pronounced near the arterial anastomosis, but in case, if it feels more accentuated at any other place of the course of the graft, it raises the possibility of stenosis.

#physicalexam
#nephrology



References: 

1.  Beathard GA. Physical examination of the dialysis vascular access. Semin Dial 1998; 11:231.

2. Leon C, Orozco-Vargas LC, Krishnamurthy G, et al. Accuracy of physical examination in the detection of arteriovenous graft stenosis. Semin Dial 2008; 21:85.