CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S26-S27
DOI: 10.1055/s-0041-1730718
Abstract

Incidence and Percutaneous Management of Arterial Emboli Occurring During Hemodialysis Graft Recanalization

Dong Erk Goo
Soonchunhyang University Hospital, Seoul, South Korea
,
Yong Jae Kim
Soonchunhyang University Hospital, Seoul, South Korea
› Author Affiliations

Background: Embolization of clot fragments in the feeding artery is a possible complication of percutaneous declotting procedure in hemodialysis graft patients. We describe the incidence and management of accidental arterial emboli during dialysis graft declotting procedures. Methods: Between August 1997 and August 2012, 2484 patients (961 males; 1523 females) with thrombotic occlusions of hemodialysis grafts were treated with several percutaneous techniques. Percutaneous transluminal angioplasty was performed at the stenotic lesion after thrombolysis procedure. We analyzed the incidence of arterial emboli according to the method of thrombolysis and the location of the dialysis graft by Chi-square test. Results: Arterial emboli were documented by angiography in 83 cases (3.3%) of patients. Sixty-one cases of embolization involved the brachial artery or its branches, 14 involved the ulnar artery, and 8 involved the radial artery. Two patients complained of finger pain, but it immediately subsided. The numbers and incidence of arterial emboli according to the thrombolysis method are given. Arterial emboli were retrieved by occlusion balloon/fogarty balloon (45), guiding catheter-assisted aspiration (15), observation without intervention (16), sheath assisted aspiration (2), back-bleeding technique (3), and others (2). Subsequent fistulograms obtained in 26 patients and demonstrated arterial stenosis in 2 patients. Follow-up fistulogram demonstrated complete resolution of the observation emboli in three of four patients. Conclusion: Arterial emboli are seldom occurrence during percutaneous dialysis graft thrombectomy procedure, and the majority can be easily retrieved by percutaneous techniques. Clinical observation also appears to be indicated in asymptomatic patients.



Publication History

Article published online:
11 May 2021

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