Abstract
A functional hemodialysis vascular access is the lifeline for patients with end-stage
kidney disease and is considered a major determinant of survival and quality of life
in this patient population. Hemodialysis therapy can be performed via arteriovenous
fistulas, arteriovenous grafts, and central venous catheters (CVCs). Following dialysis
vascular access creation, the interplay between several pathologic mechanisms can
lead to vascular luminal obstruction due to neointimal hyperplasia with subsequent
stenosis, stasis, and eventually access thrombosis. Restoration of the blood flow
in the vascular access circuit via thrombectomy is crucial to avoid the use of CVCs
and to prolong the life span of the vascular access conduits. The fundamental principles
of thrombectomy center around removing the thrombus from the thrombosed access and
treating the underlying culprit vascular stenosis. Several endovascular devices have
been utilized to perform mechanical thrombectomy and have shown comparable outcomes.
Standard angioplasty balloons remain the cornerstone for the treatment of stenotic
vascular lesions. The utility of drug-coated balloons in dialysis vascular access
remains unsettled due to conflicting results from randomized clinical trials. Stent
grafts are used to treat resistant and recurrent stenotic lesions and to control extravasation
from a ruptured vessel that is not controlled by conservative measures. Overall, endovascular
thrombectomy is the preferred modality of treatment for the thrombosed dialysis vascular
conduits.
Keywords
arteriovenous - graft - fistula - declot - thrombectomy - device - stent - balloon
- access - interventional radiology
