title: Distal digital embolization from a thrombosed aneurysmal hemodialysis arteriovenous fistula: the benefit of a hybrid approach.
abstract: Aneurysmal degeneration of a hemodialysis arteriovenous fistula (AVF) is common; however, distal digital embolization from an AVF is extremely rare. Even though the ultimate fate of all arteriovenous hemodialysis access is thrombosis with minimal consequences, dislodgement of thrombus at the proximal anastomosis could lead to ischemia of the distal arterial circulation. We here present a case of a renal transplant patient with a thrombosed aneurysmal AVF who presented with acute digital ischemia successfully treated with combination catheter-directed thrombolysis and open repair. No similar report was found describing this entity treated with this approach.
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. hsimosa@bidmc.harvard.edu
authors.forename: Hector F
authors.initials: HF
authors.lastname: Simosa
authors.forename: Sravani V
authors.initials: SV
authors.lastname: Mudumbi
authors.forename: Frank B
authors.initials: FB
authors.lastname: Pomposelli
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D000792:Angiography; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001916:Brachial Artery; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D018616:Ultrasonography, Doppler, Duplex