You find this patient’s AVF to be hypopusatile with a weak thrill. Now, you decide to perform the “arm elevation test”. What do you see?
The “arm elevation test” seen above is helpful in “ruling out” which one of the following:
Outflow stenosis
Correct! With normal outflow or in the absence of outflow stenosis, elevation of the arm should lead to collapse of the AVF/aneurysms. If there is no collapse, an outflow stenosis may be seen under fistulagram.
Inflow stenosis of AVF
Unfortunately, this test does not give us information about the presence or absence of an inflow stenosis. Try again!
Thrombosis of AVF
Unfortunately, this test does not give us information about the presence of AVF thrombosis. Try again!
Steal syndrome
Unfortunately, this test does not give us information about the presence of steal syndrome. If there is concern for steal syndrome, we might compress the AVF and look for improvement in the patient’s signs/symptoms of steal syndrome. Try again!
Now, you perform the “pulse augmentation test”. The test is helpful in “ruling out” which of the following.
Outflow stenosis
Hm, this is not the best test to look for outflow stenosis. Try again!
Inflow stenosis of AVF
You got it! In the absence of inflow stenosis, the application of pressure to the outflow of the AVF should lead to augmentation in the pulse between the arterial anastomosis and applied pressure. If an inflow stenosis is present, pulse augmentation will not be appreciated.
Thrombosis of AVF
Unfortunately, this test does not give us information about the presence of AVF thrombosis. Try again!
You perform this test at the bedside, and do not appreciate augmentation of the pulse.
Click here when you’re confident in your diagnosis!
Case 9 Index
Case 9 Introduction
Case 9 Physical Exam