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Thrombosed hemodialysis access as an unusual source of emboli in the upper extremity of a kidney transplant recipient
Author(s) -
Kim MiHyeong,
Hwang Jeong Kye,
Chun Ho Jong,
Moon In Sung,
Kim Ji Il
Publication year - 2014
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12118
Subject(s) - medicine , arteriovenous fistula , embolization , thrombolysis , hemodialysis , surgery , radiology , kidney transplantation , aneurysm , catheter , embolism , dialysis catheter , anastomosis , hemodialysis catheter , transplantation , cardiology , myocardial infarction
Arteriovenous fistula ( AVF ) is no longer used in kidney transplant recipients. However, there is no consensus regarding whether or not to ligate a well‐functioning AVF after successful kidney transplantation, particularly in patients with well and stably functioning kidney transplants. Most AVF s without complications are left in situ and more than one‐third of native AVF s close spontaneously. The currently accepted policy toward thrombosed AVF s is retention within the patient's extremity without treatment. These thrombosed AVF s seldom cause serious problems. However, when combined with aneurysmal dilatation of the proximal vein adjacent to the arterial anastomotic area, the AVF could act as the source of distal arterial emboli. This is very similar clinical scenario to that observed in embolization from a peripheral arterial aneurysm. Here we describe a case report of upper extremity ischemia following massage of a thrombosed aneurysmal AVF . The patient was successfully treated with a combination of catheter‐directed thromboaspiration, thrombolysis, and surgical repair of the thrombosed AVF . To the best of our knowledge, this is the first report of upper extremity embolism after massage of a thrombosed aneurysmal AVF involving this combined treatment.