Declotting the Thrombosed Access

Quencer, Keith; Friedman, Tamir

doi:10.1053/j.tvir.2016.11.007

Cited by 47 publications

(48 citation statements)

References 57 publications

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“…It is also the leading cause of permanent vascular access loss. Access thrombosis accounts for 65 to 85% of cases of permanent vascular access loss 11 . In the present case, the hemodialysis treatment was complicated by recurrent thrombosis of the AVFs.…”

Section: Discussionmentioning

confidence: 99%

Primary antiphospholipid syndrome in a hemodialysis patient with recurrent thrombosis of arteriovenous fistulas

Gjorgjievski¹,

Dzekova‐Vidimliski²

2020

Braz. J. Nephrol.

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Introduction: The antiphospholipid syndrome is a systemic autoimmune disease defined by recurrent vascular and/or obstetrical morbidity that occurs in patients with persistent antiphospholipid antibodies. Case presentation: A patient on hemodialysis with a primary antiphospholipid syndrome presented with recurrent vascular access thrombosis, obstetrical complications, and positive lupus anticoagulant. The patient had multiple arteriovenous fistulas that failed due to thrombosis. The obstetrical morbidity was defined by one miscarriage at the 7th week of gestation and a pregnancy complicated by pre-eclampsia with preterm delivery at the 28th week of gestation. A thorough thrombophilia screening confirmed the presence of antiphospholipid antibody. Lupus anticoagulant was present in plasma, measured on two occasions 12 weeks apart. Conclusion: Thrombophilias are inherited or acquired predispositions to vascular thrombosis and have been associated with thrombosis of the arteriovenous fistula. Patients on hemodialysis with recurrent vascular access thrombosis and presence of thrombophilia should be evaluated about the need for anticoagulant therapy with a vitamin K antagonist.

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Section: Discussionmentioning

confidence: 99%

Primary antiphospholipid syndrome in a hemodialysis patient with recurrent thrombosis of arteriovenous fistulas

Gjorgjievski¹,

Dzekova‐Vidimliski²

2020

Braz. J. Nephrol.

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“…Endovascular interventions are associated with embolization (21-23), in particular arterial emboli, which occur in >6% of patients receiving percutaneous declotting (24,25). To avoid severe adverse effects, a methodical approach to patient selection is important and patients with contraindications for each procedure should be excluded (2,24). Taking the efficacy and safety into account, the optimal available declotting procedure should be selected for each given patient with a thrombosed fistula.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombosis is a common complication of autologous arteriovenous fistulas (AVF) for hemodialysis access in patients with end-stage renal disease (1). AVF thrombosis accounts for 65-85% of permanent access loss (2). Following the creation of AVFs, early-onset thrombosis is due to inadequate blood inflow and late-onset thrombosis is associated with stenotic lesions (1,3,4).…”

Section: Introductionmentioning

confidence: 99%

“…Urokinase has been successfully used as a thrombolytic agent for resolving thrombosed vascular access (6,7). Previously, urokinase was administered through a 22-gauge angiographic catheter introduced into the fistula prior to percutaneous interventions, also known as the 'lyse and wait' technique (2,8). Pulse-spray-aided pharmacomechanical thrombolysis employs the administration of tissue plasminogen activator and mechanical declotting techniques (9).…”

Section: Introductionmentioning

confidence: 99%

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Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas

et al. 2019

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Arteriovenous fistula (AVF) thrombosis is a common complication in patients undergoing hemodialysis, and early intervention is required. Urokinase has been used as a thrombolytic agent for declotting the thrombosed access. However, the optimal route for infusing urokinase remains to be determined. In the present retrospective observational study, 49 patients who underwent local venous infusion and 57 patients with peripheral venous infusion of urokinase were included. A urokinase dosage of 300,000 U was administered until successful thrombolysis, which was a maximum of three times. Age, sex, period of dialysis, time of AVF placement, systolic and diastolic blood pressure and thrombus age were similar between the two groups. The efficacy of urokinase infusion via the two routes in resolving thrombosed AVFs, defined as successful fibrinolysis, and the safety, defined as the number of bleeding events, was compared. The cumulative thrombolysis success rate following three sessions of thrombolytic therapy in the local venous thrombolysis group was higher compared with that in the peripheral venous thrombolysis group (85.7 vs. 68.4%; P=0.04). The local thrombolysis group exhibited less ecchymosis (4.1 vs. 14.0%; P=0.07), epistaxis (2.0 vs. 10.5%; P=0.08) and gingival bleeding (4.1 vs. 19.3%; P=0.02) events compared with the peripheral thrombolysis group. Further analyses demonstrated that systolic [odds ratio (OR)=1.10; 95% confidence interval (CI), 1.03-1.17; P<0.01] and diastolic (OR=1.08; 95% CI, 1.02-1.14; P<0.05) blood pressure were protective factors, whereas thrombus age (OR=0.91; 95% CI, 0.84-0.99; P<0.05) was a risk factor for thrombolysis success among patients who underwent local thrombolytic therapy. Overall, the results suggest that local venous infusion of urokinase is superior to peripheral venous infusion for the treatment of patients with thrombosed fistulas.

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“…AVF recanalization is performed in the routine practice of interventional radiology and its importance is increasing due to high population of patients with end stage kidney disease. Acute thrombosis of native AVF should be treated on the same day if possible and interventional procedures include mechanical thrombectomy or manual aspiration thrombectomy and/or thrombolysis procedures [10]. Manual aspiration thrombectomy procedure has a lower cost and no need to use thrombolytic agents.…”

Section: Discussionmentioning

confidence: 99%

Haemostasis with suture-tourniquet technique following removal of large-bore venous sheaths for endovascular recanalization of acute thrombosis in native arteriovenous fistula

Ballı¹

2019

J Radiol Oncol

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Purpose: To investigate the suture-tourniquet technique for haemostasis in patients with acute thrombosis of native arteriovenous fi stula (AVF) whom underwent manual aspiration thrombectomy using large-bore venous sheaths and high dose heparin. , patients with acute AVF thrombosis performed successful manual aspiration thrombectomy by using large bore venous sheaths and high dose heparin were included in this retrospective study. Success rate for haemostasis, procedural complications clinical and imaging follow up was reported descriptively.Results: A total of 52 patients with 64 procedures met the inclusion criteria. In 60(94%) of 64 procedures, successful haemostasis was achieved with suture-tourniquet technique. In 2(3.1%) of the 64 procedures, the suture broke while turning the tourniquet and haematoma occurred in another 3 procedures (4.7%) although suture-tourniquet technique was applied appropriately. Manual compression was performed in these patients. There were 3 major complications unrelated the suture-tourniquet technique. Conclusion:The suture tourniquet technique can achieve haemostasis rapidly and can be safely used with low complication rates without fi stulae thrombosis after large-bore venous sheath removal following treatment of AVF thrombosis.How to cite this article: Balli O. Haemostasis with suture-tourniquet technique following removal of large-bore venous sheaths for endovascular recanalization of acute thrombosis in native arteriovenous fi stula.

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Declotting the Thrombosed Access

Cited by 47 publications

References 57 publications

Primary antiphospholipid syndrome in a hemodialysis patient with recurrent thrombosis of arteriovenous fistulas

Primary antiphospholipid syndrome in a hemodialysis patient with recurrent thrombosis of arteriovenous fistulas

Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas

Haemostasis with suture-tourniquet technique following removal of large-bore venous sheaths for endovascular recanalization of acute thrombosis in native arteriovenous fistula

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