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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 12/2017

01-12-2017 | Clinical Investigation

Arterial Embolism Occurring During Percutaneous Thrombectomy of Dialysis Graft

Authors: D. E. Goo, S. B. Yang, Y. J. Kim, J. M. Lee, W. H. Lee, D. Song, S. I. Park

Published in: CardioVascular and Interventional Radiology | Issue 12/2017

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Abstract

Purpose

To evaluate the incidence, management methods and follow-up results of arterial embolism during percutaneous thrombectomy of hemodialysis grafts.

Materials and Methods

After Institutional Review Board approval, the radiologic database of our department for percutaneous thrombectomy procedure in hemodialysis access was retrospectively reviewed. Between 1998 and June 2014, 2975 percutaneous thrombectomy procedures using thromboaspiration technique were performed in 1524 patients with thrombosed hemodialysis grafts. After thrombectomy, angioplasty was performed for significant stenoses. The incidence of arterial embolism was analyzed according to the location/shape of the arteriovenous graft. Percutaneous management methods of arterial embolism and long-term follow-up results by fistulography were also evaluated.

Results

Arterial embolism was documented by angiography in 117 cases (3.9%). Of these, three were symptomatic and subsided after embolectomy. The incidence was significantly correlated with the location/shape of the graft (p = 0.001). Arterial emboli were retrieved using occlusion balloon/Fogarty balloon (n = 58), guiding catheter-assisted aspiration (n = 36), sheath-assisted aspiration (n = 2) and back-bleeding technique (n = 3). Others were observed without intervention (n = 17) or surgically removed (n = 1). Arterial emboli were completely retrieved in 86 cases and partially retrieved in 13 cases. Ulnar artery rupture occurred in one case due to over-inflation of the occlusion balloon. Follow-up fistulography performed in 60 patients among whom 99 percutaneous embolectomies were done revealed arterial stenosis/occlusion in 7 and residual emboli in one patient. In observed patients without intervention, follow-up documented complete resolution of the emboli without arterial stenosis in 9 patients.

Conclusion

Radiologically perceivable arterial embolism is uncommon during percutaneous thrombectomy of thrombosed dialysis grafts. The majority of the emboli can be retrieved by percutaneous techniques, but may induce arterial damage in some patients. Clinical observation can be another option for patients without ischemic symptoms.
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Metadata
Title
Arterial Embolism Occurring During Percutaneous Thrombectomy of Dialysis Graft
Authors
D. E. Goo
S. B. Yang
Y. J. Kim
J. M. Lee
W. H. Lee
D. Song
S. I. Park
Publication date
01-12-2017
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 12/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-017-1754-6

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