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The Rapid Fistula Declot 

The Rapid Fistula Declot
Chapter:
The Rapid Fistula Declot
Author(s):

Dean C. Preddie

, and Gregg A. Miller

DOI:
10.1093/med/9780199986071.003.0049
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date: 30 September 2020

The rapid fistula declot is an endovascular approach to efficiently salvage the acutely thrombosed dialysis arteriovenous fistula (AVF). Thrombectomy of the AVF has historically been performed in the inpatient setting, but the advent of the outpatient vascular access center has vastly improved the efficiency and cost-effectiveness of dialysis access management. Fistula surveillance has generally been accepted to improve the life span of the AVF; however, due to the contribution of multiple factors, including uremia-induced vascular dysfunction, acute access thrombosis remains an issue. The rapid fistula declot is encapsulated in a simple algorithm of (1) clot removal, (2) repair of culprit stenoses, and (3) flow restoration. The preferred approach to each step is discretionary as long as near-complete evacuation of the fistula and venous outflow pathways of thrombus precedes flow restoration.

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