Thrombosed hemodialysis access as an unusual source of emboli in the upper extremity of a kidney transplant recipient

Radiofrequency Ablation of the Stellate Ganglion for Management of Acute Digital Ischemia: A Case Report

The authors present a report of a pulsed radiofrequency ablation of the stellate ganglion performed on a patient with microemboli to the hand from a thrombosed abandoned arteriovenous fistula. The patient was initially managed using vasodilators and anticoagulation. However, the patient’s skin mottling, pain, and decreased strength persisted. Ablation of the stellate ganglia increased perfusion to his hand and likely prevented amputation that has lasted for approximately 1 year. While radiofrequency ablation is more commonly used for pain syndromes, this is an example of its use in the treatment and potential treatment of acute ischemia.

Comparison between open and pharmacomechanical repair of acutely thrombosed arteriovenous hemodialysis fistulae within a decade

INTRODUCTION

Different declotting techniques are available for acutely thrombosed arteriovenous hemodialysis fistulae (AVF). The aim of this single-center study was to compare immediate and follow-up results between surgical repair and a modified interventional lyse-and-wait technique characterized by prolonged local reaction times of recombinant tissue-plasminogen activator (rtPA).

MATERIALS AND METHODS

We retrospectively analyzed medical records of 110 consecutively treated patients between the years 2003 and 2013. All patients were on hemodialysis (HD) and suffered from an acutely thrombosed AVF. The treatment standards changed in the course of time, wherefore we compared 2 groups: the open repair (OR) (N = 50) and the endovascular repair (ER) group (N = 60).

FINDINGS

We found no significant differences in success rates (OR 92%/ER 96.7%; P = 0.28), immediate failures (IFs) (OR 8%/ER 10%; P = 0.71), and temporary catheter placements (TCPs) (OR 10%/ER 6.7%; P = 0.52). Furthermore, there were no differences in cumulative primary patency rates (P = 0.42) and secondary patency rates (P = 0.97).The infection rate was significantly increased after OR (8%) compared to ER (0%); P = 0.026. The hospital stay in days was shorter after ER (5.2 ±2.8) vs. OR (9.0 ± 3.5); P < 0.001.

CONCLUSION

The modified lyse-and-wait technique with prolonged local reaction times is a successful alternative to surgical repair for acutely thrombosed AVF. Clear benefits are less infections and significant shorter hospital stays after ER. However, OR remains the preferred treatment for aneurysms and anastomotic stenoses.