Management of autogenous arteriovenous (AV) fistula thrombosis part 3

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

 

Surgical thrombectomy

Surgical thrombectomy is performed with thrombectomy catheter. Manual retrograde thrombus expression can be helpful. On-table venous outflow angiography of the recanalized vein as well as the central veins should be performed whenever possible to find/exclude additional stenosis  or residual thrombus. Identification and concurrent correction of the underlying causes of thrombosis are essential parts of any surgical or interventional declotting. The best results of surgery probabily will be encountered  after proximal re-anastomosis for anastomotic stenosis of forearm arteriovenous fistula, which is the most frequent location of stenosis  in this type of access. Primary patency of the new proximal anastomosis has been reported to be as high as 80% at 1 year and 67% at 2 years. If access failure recurs frequently in a short time period, a new fistula may need to be created.

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