Management of Thrombosed Dialysis Access Circuits

Thrombotic occlusion of autologous arteriovenous fistulas or synthetic arteriovenous grafts is a serious adverse event in hemodialysis patients and declotting should be performed before next hemodialysis session, in order to avoid a central venous catheter. Various techniques exist to declot a thrombosed vascular access, including open surgical thrombectomy, catheter-directed thrombolysis and use of different types of percutaneous thrombo-aspiration catheters and mechanical thrombectomy devices. These devices can be categorized as devices with direct wall contact and hydrodynamic devices without direct wall contact. Technical and early clinical outcome results of percutaneous hemodialysis declotting are high and ranging between 70 and 100%; late clinical patency results are much lower related to restenosis or re-thrombosis; these patency results are higher for autologous arteriovenous fistulas compared to synthetic arteriovenous grafts and mainly depend on the combined efficacy of successful thrombectomy and durable treatment of the underlying stenoses, associated with the acute thrombosis.