[Percutaneous treatment possibilities in thrombotic occlusion of Brescia-Cimino dialysis shunts]

Acute thrombotic occlusion of Brescia-Cimino forearm fistulae is a severe complication. Aspects of percutaneous therapy include balloon dilatation, thrombolysis and mechanical thrombectomy. We report on 21 cases with obstructed shunts. Clinical evaluation and palpation helped to select each shunt for an individual therapeutic approach.

One patient presented with a proximal arterial occlusion, three patients with a small occluding thrombus, 4 patients with a severe stenosis but only a small amount of thrombus and 13 patients with an extended amount of clot material.

7 patients underwent balloon dilatation alone, three patients thrombolysis with rtPA and 11 patients hydrodynamic thrombectomy. Arterialized shunt flow was reestablished in 20 of 21 cases. The shunt was reused for dialysis in 17 cases. Reobstruction within two weeks after intervention occurred in two cases.

With regard to the individual clot size, different percutaneous methods are available for successful shunt recanalisation.