CLIFF NOTES – DECLOT

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Contraindications Declot AVF
  • Immature “virgin” AVF: Cannot palpate AVF
  • Local infection: fever
  • Thrombosis for > 1 week (organized)
  • Mega Fistula: Aneurysms with large clot burden (>100 mL)
  • Recent access creation (< 4 weeks old)
  • Left to right shunt
  • >2 declot procedures in 1 month
  • K > 6 mmil/L
  • INR > 3.5
AVF vs AVG
  • AVF
    • Perform within 2 days of clotting (thrombus causes inflammation w/ time)
  • AVG
    • Declot can be successful even w/in months of clot burden
Procedure Stages:
  • Consent for HD Cath placement
  • Clot busting and removal
  • Correcting the cause of thrombosis-angioplasty stenosis
Procedure overview:
  • Place antegrade and retrograde sheaths in AVF
  • Central and Pullback venogram
  • Thrombolysis/thrombectomy
  • Balloon angioplasty
Avoid:
  • Stent migration — prevent with > 5 cm length stents