Digital manipulation of the thrombosed arterio-venous conduit

The utility of a bedside technique for digital manipulation of the thrombosed arterio-venous conduit was retrospectively reviewed. During an 18 month period the records of all patients at this institution who were undergoing chronic hemodialysis, via a forearm modified arterial bovine heterograft, and who were successfully treated by digital manipulation for graft thrombosis were examined. Thirteen patients who underwent 30 successful graft manipulations constituted the study group. Bedside manipulation attempts were performed from one to 72 hours from the period of last known function. Complete response to the technique was indicated by the appearance of a pulse and panrhythmic bruit and thrill throughout the conduit. The average duration of restored flow was 58.6 days (range one to 430 days). No serious or life threatening complications (e.g. problems related to pulmonary thromboembolism) were observed. Conduit thrombosis secondary to faculty cannulation, prior hypotension, or extrinsic compression was amenable to the technique; however, when occlusion was secondary to an intrinsic problem in the graft (stenosis of the venous or arterial anastomosis), operative revision was required. If successful, the technique allows for immediate dialysis access without the need for additional measures. The procedure has negligible morbidity and can spare the patient considerable time and expense.