Document Detail

Declotting a thrombosed Brescia-Cimino fistula by manual catheter-directed aspiration of the thrombus.
MedLine Citation:
PMID:  15602632     Owner:  NLM     Status:  MEDLINE    
Acute thrombosis of native fistulae for hemodialysis occurs more rarely than for prosthetic grafts. The vascular access should be reopened as soon as possible in order to resume regular dialysis and to avoid resorting to a temporary central line. Manual aspiration is one of the numerous methods described in this setting. Clinical examination is essential to rule out local infection, which is the only serious contraindication to percutaneous maneuvers. Two introducer-sheaths are placed in a criss-cross fashion in order to gain access to the venous outflow and to the anastomosis. Access to the venous outflow is performed first in order to check the proximal extent of the thrombosis. Heparin and antibiotics are injected systemically. A similar maneuver is then performed in the direction of the anastomosis. The aspiration phase is then initiated. A 7-9 Fr aspiration catheter is pushed through the "venous" introducer. Manual aspiration is created through a 50 ml syringe while the catheter is progressively removed with back and forth movements. The catheter and the contents of the syringe are flushed through a gauze on the working table to evaluate the amount of thrombus which has been removed and the maneuver is repeated as often as necessary to remove all the thrombus. Once all the clots located downstream from the venous introducer have been removed, any unmasked underlying stenosis is NOT dilated at this stage since it provides protection against major embolism coming from the inflow. The aspiration catheter is then pushed through the "arterial" introducer down to the anastomosis in order to aspirate the thrombus located between the tip of the introducer and the anastomosis. Dilatation of unmasked stenoses is finally performed using high-pressure balloons. The holes made by the two introducers are closed using a U-shaped suture with interposition of a short piece of plastic and the patient is sent back to the nephrologists for dialysis.
Luc A Turmel-Rodrigues
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  28     ISSN:  0174-1551     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:    2005 Jan-Feb
Date Detail:
Created Date:  2005-03-17     Completed Date:  2005-06-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-6     Citation Subset:  IM    
Radiologie Vasculaire, Diagnostique et Interventionnelle, Clinique Saint-Gatien, Tours, France.
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MeSH Terms
Arm / blood supply*
Arteriovenous Shunt, Surgical / adverse effects*
Catheters, Indwelling / adverse effects*
Radiology, Interventional / methods*
Suction / methods
Thrombosis / etiology*,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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