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https://www.readbyqxmd.com/read/29075875/lysis-assisted-balloon-lab-thrombectomy-a-declotting-technique-for-the-treatment-of-thrombosed-arteriovenous-dialysis-grafts-5-year-experience-of-241-endovascular-procedures
#1
Panagiotis M Kitrou, Panagiotis Papadimatos, Stavros Spiliopoulos, Nicolaos Christeas, Konstantinos Katsanos, Dimitris Karnabatidis
BACKGROUND: This is a retrospective single-center analysis investigating the results of a percutaneous lysis-assisted balloon (LAB) thrombectomy procedure for the treatment of thrombosed arteriovenous dialysis grafts (AVGs). MATERIALS AND METHODS: Within 5 years (January 2012-December 2016), 291 declotting procedures were performed for the treatment of thrombosed dialysis arteriovenous fistulas or grafts. Data were available for 129 patients (75 men, 58.1%) with an AVG, undergoing 241 procedures [1...
October 26, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/29026877/prolonged-delayed-renal-graft-function-secondary-to-venous-hypertension
#2
Suraj Mishra, Gaurav Gupta, I Moinuddin, Brian Strife, Uma Prasad, D Massey, Anne King, Dhiren Kumar, Chandra S Bhati
The case of a 39-year-old highly sensitized woman who underwent second renal transplantation after being on warfarin because of a history of frequent thromboses of her left femoral arteriovenous graft (AVG) is reported here. The patient received a flow cytometric positive crossmatch kidney transplant from a deceased donor. Her posttransplant course was complicated by prolonged delayed graft function (DGF) lasting for 9 months. Antibody-mediated rejection occurred in the immediate postoperative period. This resolved after treatment, and resolution was confirmed by repeat biopsy...
October 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28827013/unmasking-of-previously-asymptomatic-central-venous-stenosis-following-percutaneous-transluminal-angioplasty-of-hemodialysis-access
#3
Jarrod E Ehrie, Therese E Sammarco, Jesse L Chittams, Scott O Trerotola
PURPOSE: To determine the frequency of new-onset symptoms of central venous stenosis (CVS) after percutaneous transluminal angioplasty (PTA) of a hemodialysis access-related stenosis in patients with previously asymptomatic CVS and to identify risk factors for this phenomenon. MATERIALS AND METHODS: Retrospective review was performed of patients treated with PTA for an access-related stenosis (excluding central vein interventions) between 2001 and 2016 who returned within 3 months with symptoms of CVS (ie, "unmasking"): 39 patients met these criteria...
October 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28779788/transjugular-venous-approach-for-endovascular-intervention-in-upper-extremity-dialysis-access-fistulae-and-grafts
#4
REVIEW
Hector Ferral, Marc J Alonzo
A transjugular venous access is an alternative approach for endovascular intervention in upper-extremity dialysis arteriovenous fistulae and grafts. The transjugular access is recommended for patients who have an unfavorable anatomy for the direct arm access approach. Ultrasound evaluation of the arteriovenous access is essential before intervention and includes evaluation of the inflow artery and outflow vein diameters, arteriovenous anastomosis, and the entire outflow vein, specifically looking into potential problem areas...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28777407/management-of-hypertension-in-patients-during-percutaneous-dialysis-access-interventions
#5
Bhavika V Gandhi, Tejas B Patel, Eric J Costanzo, Avais Masud, Sushil Mehandru, Loay Salman
Not infrequently, interventionalists are faced with a patient with increased blood pressure who is about to undergo a dialysis access intervention such as tunneled hemodialysis catheter, percutaneous balloon angioplasty, or declotting procedure for a clotted arteriovenous access. This can frequently create a dilemma as functional dialysis access is needed to provide dialysis therapy and delaying treatment could result in a life-threatening situation, particularly in the presence of hyperkalemia. This article investigates hypertension in patients undergoing percutaneous dialysis access interventions and provides guidance to their management...
July 27, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28639916/benefits-of-long-versus-short-thrombolysis-times-for-acutely-thrombosed-hemodialysis-native-fistulas
#6
COMPARATIVE STUDY
Susanne Regus, Werner Lang, Marco Heinz, Michael Uder, Axel Schmid
INTRODUCTION: Local thrombolysis with a time of exposure to recombinant tissue plasminogen activator of 15 to 150 minutes is commonly used to declot acutely thrombosed hemodialysis fistulas. The duration of thrombolysis for the restoration of arteriovenous blood flow remains controversial. The aim of this study was to investigate the outcomes of long thrombolysis treatment (LTT, 3 hours or more) and short thrombolysis treatment (STT, less than 3 hours) in our institution. METHODS: We retrospectively analyzed 86 interventional declotting procedures (28 STT and 58 LTT) applied to 86 acutely thrombosed hemodialysis fistulas...
July 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28498107/ultrasound-assisted-thrombolysis-of-an-occluded-transjugular-portosystemic-shunt
#7
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...
July 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/28279408/declotting-the-thrombosed-access
#8
REVIEW
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
https://www.readbyqxmd.com/read/28248811/efficacy-of-reducing-alteplase-dose-to-restore-patency-in-nonhemodialysis-central-vascular-access-devices
#9
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
https://www.readbyqxmd.com/read/28044402/time-extended-local-rtpa-infiltration-for-acutely-thrombosed-hemodialysis-fistulas
#10
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
https://www.readbyqxmd.com/read/27470252/the-risk-of-bleeding-with-tunneled-dialysis-catheter-placement
#11
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
https://www.readbyqxmd.com/read/27301545/post-operative-intracranial-hemorrhage-related-to-using-t-pa-for-declotting-an-occluded-hemodialysis-catheter-a-cautionary-tale
#12
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
https://www.readbyqxmd.com/read/27120119/we-send-thrombosed-av-accesses-to-the-operating-room
#13
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
https://www.readbyqxmd.com/read/27015445/initial-clinical-use-of-a-novel-mechanical-thrombectomy-device-xcoiltm-in-hemodialysis-graft-and-fistula-declot-procedures
#14
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
https://www.readbyqxmd.com/read/26035977/interventional-nephrology-in-puerto-rico-a-four-year-experience
#15
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
https://www.readbyqxmd.com/read/25765659/acute-arteriovenous-access-failure-long-term-outcomes-of-endovascular-salvage-and-assessment-of-co-variates-affecting-patency
#16
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
https://www.readbyqxmd.com/read/25413181/differences-in-coagulation-in-clotting-of-vascular-access-in-hemodialysis-patients
#17
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
https://www.readbyqxmd.com/read/24790686/fatal-pulmonary-embolism-after-hemodialysis-vascular-access-declotting
#18
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
https://www.readbyqxmd.com/read/24558614/cardiac-arrest-secondary-to-bilateral-pulmonary-emboli-following-arteriovenous-fistula-thrombectomy-a-case-report-with-review-of-the-literature
#19
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
https://www.readbyqxmd.com/read/24533201/cerebrovascular-accident-secondary-to-paradoxical-embolism-following-arteriovenous-graft-thrombectomy
#20
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
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