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Nicholas Hilliard, Teik Choon See, Nadeem Shaida
Transjugular intrahepatic portosystemic shunt (TIPS) insertion is commonly performed for refractory ascites or variceal bleeding. However, TIPS dysfunction can be seen in both early and late settings, with shunt thrombosis a particular problem. Treatment of shunt dysfunction commonly involves angioplasty and re-lining, with or without embolectomy, mechanical thrombectomy, or thrombolysis. Ultrasound-assisted thrombolysis has been shown to be successful for treatment of pulmonary embolism, deep vein thrombosis, and peripheral arterial thromboembolism, but has not been described before for TIPS occlusion...
May 12, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Keith B Quencer, Tamir Friedman
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...
March 2017: Techniques in Vascular and Interventional Radiology
Ann Plohal, Krishna Schiller
Central line-associated bloodstream infections (CLABSIs) are preventable through vigilant and thorough care. When CLABSIs occurred at a facility in Southwest Arizona, the root cause analysis discovered that declotting agents, such as alteplase, were not given routinely when nonhemodialysis (non-HD) central vascular access devices (CVADs) lacked blood return. A PICO question was developed that guided the review of literature and central line care standards of practice: In the adult patients with non-HD central lines, what medications are currently recommended to restore patency? As a result of this project, our facility instituted a new protocol using a reduced dose of alteplase to restore patency to non-HD CVADs...
March 2017: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
Susanne Regus, Werner Lang, Marco Heinz, Ulrich Rother, Alexander Meyer, Veronika Almási-Sperling, Michael Uder, Axel Schmid
Introduction This study describes results of a modified local thrombolysis technique for acutely thrombosed hemodialysis (HD) arteriovenous fistulas (AVF), which is characterized by prolonged recombinant tissue plasminogen activator (rtPA) local exposure times. Contrary to the standard lyse- and- wait (L&W) technique with local reaction times of 20-40 minutes, the modified protocol allows timing of challenging angioplasty maneuvers to the next regular working day. Methods From February 2009 to April 2014, 84 patients on HD presented with 152 acutely thrombosed AVF...
January 3, 2017: Hemodialysis International
Gerald A Beathard, Aris Urbanes, Terry Litchfield
PURPOSE: The purpose of this study was to evaluate the risk of bleeding associated with tunneled dialysis catheter (TDC) placement in a large population of hemodialysis patients who were either anticoagulated or were taking antithrombotic medications. METHODS: Medical records obtained over a two-year period were queried in order to select two groups of study cases. The first was a Med group (n = 458), cases which had a TDC placed while taking the antithrombotic medications (warfarin, clopidogrel or acetylsalicylic acid [ASA]) which were not discontinued or held...
September 21, 2016: Journal of Vascular Access
Jillian Plonsker, Lee A Tan, Lorenzo F Munoz
Heparin and thrombolytic agents such as tissue plasminogen activator (t-PA) are frequently used to prevent and treat occluded hemodialysis (HD) catheters. Thrombolytic agents have not been well studied for systemic effects. We present a post-operative neurosurgical patient who experienced a symptomatic intracranial hemorrhage (ICH) after t-PA was used to treat an occluded HD catheter. This case highlights that using t-PA to treat dysfunctional catheters may be associated with ICH in neurosurgical patients. Management strategies are discussed with a review of pertinent literature...
October 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Valerie Jorge Cabrera, Ursula C Brewster
A thrombosed dialysis access can be declotted either through an open surgical procedure or a percutaneous one. In choosing how the access should be managed, a nephrologist should balance the experience and outcomes of local providers to ensure the efficient and safe salvage of the vascular access. Percutaneous procedures often offer less disruption to the schedule of the patient and dialysis clinic, give more information about the central vasculature, are less invasive, and ultimately are preferred. Nephrologist should encourage local vascular surgeons and interventional radiologists to become proficient in these procedures to avoid unnecessary open cases...
July 2016: Seminars in Dialysis
Wayne L Monsky, Richard E Latchaw
PURPOSE: We aimed to evaluate the safety and effectiveness of a novel catheter-based mechanical thrombectomy device, XCOILTM, as a first line therapy to restore patency of thrombosed dialysis grafts and fistulae. METHODS: In 2010, 18 consecutive/sequential patients (11 male, 7 female; median age, 52 years; age range, 32-69 years) with occluded arteriovenous grafts (n=15) or fistulae (n=3) were treated with XCOILTM (NexGen Medical Systems Inc.) without adjunctive thrombolytic drugs...
May 2016: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Rafael Baez, Jose Betancourt, Hector J Diaz, Javier Monserrate, Tania Ramírez, Martin Gorrochategui, Carlos Rivera Bermudez, Francisco Torre Leon, Jose L Cangianoa
Puerto Rico is one of the most prevalent areas covered by Medicare in need of renal replacement therapy for which interventional procedures are performed. A cumulative analysis of this management is reported in patients during the period between June 2007 and August 2010. Experience accumulated with 3755 surgical patients revealed that 58% had intravascular catheters, 28% had arteriovenous fistulas, 15% had arteriovenous grafts, and 2% without vascular access. Procedures performed in these patients were: catheter introduction in 1990 cases (33%), angioplasty in 751 cases (20%), angiography in 450 cases (12%), thrombectomy in 413 cases (11%) and venous mapping in 151 cases (4%)...
January 2015: Boletín de la Asociación Médica de Puerto Rico
Milind D Nikam, James Ritchie, Anu Jayanti, Ondina A Bernstein, Leonard Ebah, Paul Brenchley, Alastair Hutchison, Nicholas Chalmers, Sandip Mitra
AIMS: This study reports long-term outcomes after endovascular salvage (EVS) for acute dialysis fistula/graft dysfunction. METHODS: All patients presenting with acute fistula or graft dysfunction, excluding primary failures, referred for endovascular salvage were included in this single-centre prospective study. RESULTS: Altogether, 410 procedures were carried out in 232 patients. Overall, the incidence of thrombosis/occlusion (per patient-year) was 0...
2015: Nephron
Chinedu Nweke, Erika Martin, Todd Gehr, Donald Brophy, Daniel Carl
Arteriovenous graft (AVG) thrombosis is a frequent cause of graft failure. We evaluated coagulation protein concentrations, platelet function, and viscoelasticity factors in 20 hemodialysis (HD) patients with AVGs. The goal was to determine whether significant differences in protein concentrations, platelet function, and viscoelasticity factors exist among dialysis patients requiring frequent AVG declot procedures vs. those who do not. Twenty HD patients were enrolled: 10 frequent clotters (>3 declots in the previous year) and 10 were nonclotters...
April 2015: Hemodialysis International
Seyed-Ali Sadjadi, Maryam Sharif-Hassanabadi
PATIENT: Male, 59 FINAL DIAGNOSIS: Pulmonary embolism Symptoms: Cardiac arrest • chest pain • dyspnea MEDICATION: - Clinical Procedure: Angioplasty Specialty: Nephrology. OBJECTIVE: Rare disease. BACKGROUND: Vascular access is the lifeline of hemodialysis patients and access problems are a major source of morbidity and mortality for these patients. Access stenosis and thrombosis are common problems in dialysis patients and require prompt intervention...
2014: American Journal of Case Reports
Avni Shah, Naheed Ansari, Zaher Hamadeh
Number of patients with End Stage Renal Disease (ESRD) is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft) plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion...
2012: Case Reports in Nephrology
Jolina Pamela Santos, Zaher Hamadeh, Naheed Ansari
Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF) or arteriovenous graft (AVG). Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD), atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG...
2012: Case Reports in Nephrology
Yan Yan, Timothy W I Clark, Jeffrey I Mondschein, Richard D Shlansky-Goldberg, Mandeep S Dagli, Michael C Soulen, S William Stavropoulos, Deepak Sudheendra, Mark P Mantell, Raphael D Cohen, Sidney Kobrin, Jesse L Chittams, Scott O Trerotola
PURPOSE: To compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs). MATERIALS AND METHODS: A total of 591 hemodialysis accesses (195 transposed AVFs [tAVFs], 205 nAVFs, 191 AVGs) in 522 patients (278 male; mean age, 57 y; range, 15–91 y) underwent percutaneous transluminal angioplasty (PTA) and/or mechanical thrombectomy (ie, declotting)...
December 2013: Journal of Vascular and Interventional Radiology: JVIR
Pietro Manuel Ferraro, Gianmarco Lombardi, Francesca D'Ascenzo, Fabio Aureli, Antonio Sturniolo
INTRODUCTION: Arteriovenous fistula (AVF) salvage procedures play a crucial role in the care of the uremic patient, influencing quality of life and overall survival. In this study, we report on our centre's experience and analyse the outcomes, in terms of cumulative patency, of surgical salvage procedures on complicated AVFs. METHODS: Our study included patients who underwent surgical salvage procedures of their AVFs in our centre from 22/12/2009 to 29/12/2011. Early and late salvage procedures were analysed separately...
May 2013: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Timothy A Pflederer
Preservation of hemodialysis graft function is a high priority. Graft thrombosis is a common problem that can be treated percutaneously using a variety of methods, including pharmacological thrombolysis, balloon thrombectomy, and mechanical thrombectomy. These treatments provide similar clinical efficacy and primary patency rates, but differ in their risk for potential complications such as bleeding and pulmonary microembolization. The rheolytic thrombectomy catheter is discussed as an option for hemodialysis graft declotting...
May 2004: Journal of Invasive Cardiology
Dong Erk Goo, Seung Boo Yang, Yong Jae Kim, Chul Moon, Dan Song, Sang Chul Yoon, Woong Hee Lee
PURPOSE: We aimed to evaluate the effectiveness of the Fogarty balloon application in dislodging residual thrombus at the sheath entry point in a graft by using single apex puncture to declot thrombosed hemodialysis loop grafts. MATERIALS AND METHODS: The apex puncture technique was used in 520 cases to declot 376 hemodialysis loop grafts (male/female, 150/226; mean age, 58 years). The Fogarty balloon application technique, which uses the Fogarty balloon to the apex, was used to compress or displace the sheath entry point residual thrombus that did not wash away spontaneously by arterial ...
March 2013: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Charles Wiltrout
No abstract text is available yet for this article.
June 2010: Seminars in Interventional Radiology
Steven Wu, Iftikhar Ahmad, Sohail Qayyum, Stephan Wicky, Sanjeeva P Kalva
BACKGROUND AND OBJECTIVES: The safety of percutaneous endovascular declotting procedures for thrombosed hemodialysis fistulae/grafts is well described in the general population; however, its safety in the presence of a patent foramen ovale (PFO) is not known. The objective of this study is to assess the incidence of symptomatic paradoxical embolic events associated with declotting procedure of thrombosed arteriovenous (AV) graft or fistula in patients with documented PFO. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective study in a hospital-based, academic practice...
June 2011: Clinical Journal of the American Society of Nephrology: CJASN
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