The rare complication caused by thrombus shedding during arteriovenous fistula thrombolysis: a case report

Arteriovenous fistula is the lifeline of maintenance for patients requiring hemodialysis, with thrombosis being a common complication of this procedure. Traditionally, thrombi have been removed via thrombectomy. In recent years, it has been reported that newly occurring thrombi can be treated by urokinase thrombolysis. However, the thrombus shedding in the process should be valued, which may cause the distal limb ischemia syndrome. The complication of thrombolysis is rare but serious. Patients will experience pain and numbness, and possibly even extremity necrosis may occur without diagnosed or treated timely. There are not any reports about the occurrence or treatment of distal limb ischemia syndrome caused by thrombus shedding during thrombolysis.

Considering the thrombosis volume and texture of this case, we attempted to use urokinase thrombolysis to resolve the thrombus in fistula. During thrombolysis, thrombus shedding occurred in the distal limb. The patient's fingers of the limbs on the side of the internal fistula were pale, numb, and painful in the case. Fortunately, we solved the problem ultimately by continuously pumping urokinase. The heparin, urokinase, infusion pumps, ultrasound, and infrared therapy devices were obtained from the Affiliated Hospital of Chuanbei Medical College. Their usage and dosage are described in the relevant literature and China's 2020 blood purification standard operating procedures.

In the process of thrombolysis of arteriovenous fistula, attention should be paid to thrombus shedding. Distal limb ischemia syndrome is a rare but serious complication of thrombus shedding. Continued pumping of urokinase may be effective for this complication.