acute thrombosis of arterio-venous fistula (avf) salvaged by … · regular twice a week...
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Acute Thrombosis of Arterio-Venous Fistula (AVF) salvaged by Pharmaco-mechanical management by Alteplase: A
thrilling episode !
Dr. Amit Goel, Dr. Neeraj Bhalla
BLK Super Speciality Hospital, New Delhi, India
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Disclosure
Dr. Amit Goel.
I do not have any potential conflict of interest
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Introduction
• The thrombosis of hemodialysis fistula or graft, is an acuteevent that can interrupt dialysis treatment and it may beconsidered a clinical emergency.
• Prompt clinical recognition and timely management isnecessary to restore access patency.
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• A 30 year old female with end stage renal disease (ESRD), onregular twice a week hemodialysis for 6 month duration camewith complaints of sudden onset pain and swelling of leftupper limb on the day following her regular hemodialysissession.
• Clinically, there was tenderness and absence of thrill over theleft radio-cephalic fistula. Ultrasound doppler revealedpresence of thrombus at anastomotic site with no blood flow.
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Venogram
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Conclusion
• The goal to treat thrombosed dialysis fistula is restoration andmaintenance of the access function as long as possible
• Pharmaco-mechanical catheter directed thrombolysis is a minimallyinvasive procedure with rapid lysis and high procedural success andpatency rate and no major complications
• Specialised infusion catheter (EKOS Endowave) are available however, inour setup locally fashioned multiside hole MPA catheter are equallysuccessful
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Thank You
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Acute Thrombosis of Arterio-Venous Fistula (AVF) salvaged by Pharmaco-mechanical management by Alteplase: A
thrilling episode !
Dr. Amit Goel, Dr. Neeraj Bhalla
BLK Super Speciality Hospital, New Delhi, India