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Kidney Week

Abstract: PO1363

Arterial Emboli in the Setting of Prolonged Dialysis Access Thrombosis

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Albalas, Alian, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Almehmi, Sloan, The University of Alabama at Birmingham, Birmingham, Alabama, United States
Introduction

Thrombosis of the dialysis access is a frequent complication that is encountered in dialysis patients and is associated with poor access outcomes. Delaying dialysis access thrombectomy decreases the chances of re-establishing the flow within the access circuit. However, it is unclear whether this delay would be associated with emboli of the arterial tree. Here we report on two patients in which the access declotting was delayed resulting in arterial emboli.

Case Description

Patient 1: A 32-year-old male with a history of end stage renal disease (ESRD) on hemodialysis via right upper arm HeRO graft who presented with clotted access and volume overload. Due to the severe respiratory distress, he underwent a temporary catheter insertion and urgent dialysis. He came back after 4 days for access declotting. Initial arteriogram revealed right axillary and brachial artery emboli that was removed successfully using tissue plasminogen activator (tPA) catheter infusion followed by and Fogarty balloon.
Patient 2: A 65 yr. old male with ESRD on hemodialysis via right upper extremity AV graft who presented with clotted access for one week. The angiogram revealed total occlusion of the venous anastomosis that was treated with angioplasty. The arteriogram demonstrated an embolus within the brachial artery distal to the anastomosis and another embolus in the distal radial artery. Both emboli were treated successfully with selective tPA infusion using Kumpe catheter.

Discussion

These two cases showed that prolonged dialysis access thrombosis can be complicated with arterial embolic events that require high suspicion and immediate treatment.