The radiological management of the thrombosed arteriovenous dialysis fistula

Patent vascular access is a prerequisite for adequate haemodialysis, and is a major determinant of quality of life and long-term survival of patients with end-stage renal disease. Autogenous haemodialysis fistulas (AVFs) have demonstrated superior clinical outcome when compared to synthetic grafts,...

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Bibliographic Details
Published in:Clinical radiology 2011-01, Vol.66 (1), p.1-12
Main Authors: Bent, C.L, Sahni, V.A, Matson, M.B
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Arteriovenous Shunt, Surgical - adverse effects
Biological and medical sciences
Emergency and intensive care: renal failure. Dialysis management
Humans
Intensive care medicine
Kidney Failure, Chronic - therapy
Medical sciences
Radiography
Radiology
Radiology, Interventional - methods
Renal Dialysis - adverse effects
Renal Dialysis - methods
Salvage Therapy - methods
Thrombectomy - methods
Thrombolytic Therapy - adverse effects
Thrombolytic Therapy - methods
Thrombosis - diagnostic imaging
Thrombosis - prevention & control
Thrombosis - surgery
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Summary:Patent vascular access is a prerequisite for adequate haemodialysis, and is a major determinant of quality of life and long-term survival of patients with end-stage renal disease. Autogenous haemodialysis fistulas (AVFs) have demonstrated superior clinical outcome when compared to synthetic grafts, but both types of access remain susceptible to venous stenoses, and consequent thrombotic occlusion. Recent publications have reported primary patency rates of up to 100% following percutaneous de-clotting of AVFs incorporating techniques such as pharmacological thrombolysis, mechanical thrombectomy, and thrombo-aspiration. Endovascular management also provides information regarding the underlying cause of access thrombosis, with option to treat. Consequently, there has been a paradigm shift in the management of fistula thrombosis, with interventional radiology assuming a lead role in initial salvage procedures. This article will attempt to provide the reader with an insight into the multiple radiological techniques that can be employed to salvage a thrombosed AVF based on current published literature.
ISSN:0009-9260
1365-229X
DOI:10.1016/j.crad.2010.05.010