Management of Thrombosed Dialysis Access Circuits

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Thrombotic occlusion of arteriovenous fistulas (AVFs) or grafts (AVGs) is a common complication in hemodialysis patients.
• Timely declotting is essential to prevent central venous catheter (CVC) use, associated with higher morbidity and mortality.
• Effective management of thrombosed vascular access is critical for maintaining hemodialysis treatment continuity.

Purpose of the Study:

• To review and compare various declotting techniques for thrombosed hemodialysis vascular access.
• To evaluate the technical and clinical outcomes of percutaneous declotting procedures.
• To identify factors influencing late clinical patency after thrombectomy.

Main Methods:

• Review of existing literature on thrombectomy techniques for hemodialysis vascular access.
• Categorization of percutaneous devices into direct wall contact and hydrodynamic types.
• Analysis of technical success rates, early clinical outcomes, and late patency data.

Main Results:

• Percutaneous declotting techniques demonstrate high technical success rates (70-100%).
• Early clinical outcomes are favorable, but late patency rates are significantly lower due to restenosis or re-thrombosis.
• Autologous AVFs exhibit better late patency than synthetic AVGs, emphasizing the importance of treating underlying stenoses.

Conclusions:

• Percutaneous declotting is an effective option for acute thrombotic occlusion of hemodialysis vascular access.
• Achieving durable late patency requires not only successful thrombectomy but also comprehensive management of associated stenotic lesions.
• Optimizing treatment strategies for AVFs and AVGs is crucial for long-term vascular access function in hemodialysis patients.