Problematic Declots: Complications and Irritations

Percutaneous declotting of thrombosed dialysis grafts is performed using a variety of techniques with both mechanical devices and pharmacologic agents. Untoward events are uncommon but do occur. This article summarizes common complications and pitfalls encountered with percutaneous graft declotting. Management options are reviewed with an emphasis on those problems that can be successfully managed in the interventional radiology suite.

KEYWORDS

Percutaneous declotting - complications - thrombolysis - hemodialysis graft

REFERENCES

• 1 Funaki B, Kim R, Lorenz J et al.. Using pullback pressure measurements to identify venous stenoses persisting after successful angioplasty in failing hemodialysis grafts.  AJR Am J Roentgenol. 2002;  178 1161-1165
• 2 Hausegger K A, Tiessenhausen K, Klimpfinger M, Raith J, Hauser H, Tauss J. Aneurysms of hemodialysis access grafts: treatment with covered stents: a report of three cases.  Cardiovasc Intervent Radiol. 1998;  21 334-337
• 3 Najibi S, Bush R L, Terramani T T et al.. Covered stent exclusion of dialysis access pseudoaneurysms.  J Surg Res. 2002;  106 15-19
• 4 Ryan J M, Dumbleton S A, Doherty J, Smith T P. Technical innovation. Using a covered stent (wallgraft) to treat pseudoaneurysms of dialysis grafts and fistulas.  AJR Am J Roentgenol. 2003;  180 1067-1071
• 5 Fukasawa M, Matsushita K, Araki I, Tanabe N, Takeda M. Self-reversed parallel wire balloon technique for dilating unyielding strictures in native dialysis fistulas.  J Vasc Interv Radiol. 2002;  13 943-945
• 6 Zaleski G X, Funaki B, Rosenblum J, Theoharis J, Leef J. Metallic stents deployed in synthetic arteriovenous hemodialysis grafts.  AJR Am J Roentgenol. 2001;  176 1515-1519
• 7 Funaki B, Szymski G X, Leef J A, Rosenblum J D, Burke R, Hackworth C A. Wallstent deployment to salvage dialysis graft thrombolysis complicated by venous rupture: early and intermediate results.  AJR Am J Roentgenol. 1997;  169 1435-1437
• 8 Welber A, Schur I, Sofocleous C T, Cooper S G, Patel R I, Peck S H. Endovascular stent placement for angioplasty-induced venous rupture related to the treatment of hemodialysis grafts.  J Vasc Interv Radiol. 1999;  10 547-551
• 9 Raynaud A C, Angel C Y, Sapoval M R, Beyssen B, Pagny J Y, Auguste M. Treatment of hemodialysis access rupture during PTA with Wallstent implantation.  J Vasc Interv Radiol. 1998;  9 437-442
• 10 Pappas J N, Vesely T M. Vascular rupture during angioplasty of hemodialysis graft-related stenoses.  J Vasc Access. 2002;  3 120-126
• 11 Trerotola S O, Johnson M S, Shah H, Namyslowski J. Backbleeding technique for treatment of arterial emboli resulting from dialysis graft thrombolysis.  J Vasc Interv Radiol. 1998;  9 141-143
• 12 Murray S P, Kinney T B, Valji K, Roberts A C, Rose S C, Oglevie S B. Early rethrombosis of clotted hemodialysis grafts: graft salvage achieved with an aggressive approach.  AJR Am J Roentgenol. 2000;  175 529-532
• 13 Vorwerk D, Konner K, Schurmann K, Gunther R W. A simple trick to facilitate bleeding control after percutaneous hemodialysis fistula and graft interventions.  Cardiovasc Intervent Radiol. 1997;  20 159-160
• 14 Vesely T M. Use of a purse string suture to close a percutaneous access site after hemodialysis graft interventions.  J Vasc Interv Radiol. 1998;  9 447-450
• 15 Zaleski G X, Funaki B, Gentile L, Garofalo R S. Purse-string sutures and miniature tourniquet to achieve immediate hemostasis of percutaneous grafts and fistulas: a simple trick with a twist.  AJR Am J Roentgenol. 2000;  175 1643-1645