Declotting the Thrombosed Access

Tech Vasc Interv Radiol. 2017 Mar;20(1):38-47. doi: 10.1053/j.tvir.2016.11.007. Epub 2016 Nov 29.

Abstract

Because a patent access is the lifeline for a dialysis patient, access declotting is extremely important. Before embarking on a declot, it is important to evaluate the patient for potential contraindications such as pulmonary hypertension, right-to-left shunts and access infection in order to be able to avoid potential complications such as symptomatic pulmonary embolism, stroke, and sepsis. Multiple methods to perform a percutaneous declot exist. Four common methods are described here. We also discuss how to avoid causing an arterial embolism and how to treat it if it does occur.

Keywords: Clotted dialysis access; Iatrogenic arterial embolism; Pulse-spray aided pharmacomechanical thrombolysis.

Publication types

  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Embolism / etiology
  • Embolism / prevention & control
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / methods
  • Female
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Iatrogenic Disease
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Risk Factors
  • Thrombectomy* / adverse effects
  • Thrombectomy* / methods
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / methods
  • Thrombosis / diagnostic imaging
  • Thrombosis / etiology
  • Thrombosis / physiopathology
  • Thrombosis / therapy*
  • Treatment Outcome
  • Ultrasonography
  • Vascular Patency