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.
Copyright © 2017 Elsevier Inc. All rights reserved.
MeSH terms
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Aged
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Aged, 80 and over
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Angiography
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Arteriovenous Shunt, Surgical / adverse effects*
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Blood Vessel Prosthesis Implantation / adverse effects*
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Embolism / etiology
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Embolism / prevention & control
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Endovascular Procedures* / adverse effects
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Endovascular Procedures* / methods
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Female
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Graft Occlusion, Vascular / diagnostic imaging
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Graft Occlusion, Vascular / etiology
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Graft Occlusion, Vascular / physiopathology
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Graft Occlusion, Vascular / therapy*
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Humans
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Iatrogenic Disease
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Kidney Failure, Chronic / diagnosis
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Kidney Failure, Chronic / therapy*
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Male
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Middle Aged
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Renal Dialysis*
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Risk Factors
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Thrombectomy* / adverse effects
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Thrombectomy* / methods
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Thrombolytic Therapy* / adverse effects
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Thrombolytic Therapy* / methods
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Thrombosis / diagnostic imaging
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Thrombosis / etiology
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Thrombosis / physiopathology
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Thrombosis / therapy*
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Treatment Outcome
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Ultrasonography
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Vascular Patency