title: Declotting the Thrombosed Access.
abstract: Because a patent access is the lifeline for a dialysis patient, access declotting is extremely important. Before embarking on a declot, it is important to evaluate the patient for potential contraindications such as pulmonary hypertension, right-to-left shunts and access infection in order to be able to avoid potential complications such as symptomatic pulmonary embolism, stroke, and sepsis. Multiple methods to perform a percutaneous declot exist. Four common methods are described here. We also discuss how to avoid causing an arterial embolism and how to treat it if it does occur.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of California, San Diego, San Diego, CA. Electronic address: kbquencer@gmail.com.
authors.forename: Keith B
authors.initials: KB
authors.lastname: Quencer
authors.affiliation: Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Tamir
authors.initials: T
authors.lastname: Friedman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency
keywords: Clotted dialysis access; Iatrogenic arterial embolism; Pulse-spray aided pharmacomechanical thrombolysis