Thrombectomy approach for access maintenance in the end stage renal disease population: a narrative review

OBJECTIVE: This article reviews current practices and outcomes in endovascular thrombectomy techniques for the treatment of thrombosed arteriovenous grafts (AVGs) and fistulas (AVFs). BACKGROUND: Arteriovenous (AV) access allows patients with end-stage renal disease (ESRD) to receive hemodialysis. Thrombosis of AV access can lead to delay in hemodialysis or abandonment of access requiring dialysis catheter placement. Endovascular approach has become the preferred treatment option for thrombosed access over surgery. Interventions include removal of thrombus from the AV circuit and treatment of the underlying anatomical abnormality, such as an anastomotic stenosis. Thrombolysis, or the act of dissolving thrombus, is performed by using infusion catheters or pulse injector devices for the administration of fibrinolytic agents. Thrombectomy, or the mechanical removal of thrombus, is performed by using embolectomy balloon catheters, rotating baskets or wires, rheolytic and aspiration mechanisms. Adjunctive methods such as cutting balloon angioplasty, drug-coated balloon (DCB) angioplasty, and stent placement are also used to treat stenoses in the AV circuit. Complications of these procedures include vessel rupture, arterial embolism, pulmonary embolism (PE), and paradoxical embolism to the brain. METHODS: This narrative review article was written based on literature search from electronic databases, including PubMed and Google Scholar. CONCLUSIONS: The understanding of thrombectomy techniques and their potential complications is essential in the management of patients with thrombosed AV access.