Overview
Infection of hemodialysis arteriovenous fistulas (AVFs) complicates vascular access management, often leading to thrombosis and potential loss of the access site 1. Chronic organized thrombi pose significant challenges due to their resilient nature and volume, necessitating specialized interventions for recanalization 1.Diagnosis
Clinical Presentation: Signs of infection (fever, pain, erythema, purulent drainage) alongside thrombosis 1.
Imaging: Duplex ultrasonography to assess patency and identify thrombi 1.
Laboratory Tests: Blood cultures, inflammatory markers (CRP, WBC count) to confirm infection 1.Management
First-Line Treatment: Antimicrobial therapy tailored to culture and sensitivity results 1.
Thrombectomy: Use of vascular snare with multiple loops for chronic organized thrombi shows high success rates (anatomic success 96.6%, clinical success 100%) 1.
Anticoagulation: Consideration post-thrombectomy to prevent recurrence, specific dosing not detailed 1.Special Populations
No Specific Data Provided: Abstracts do not cover pregnancy, pediatrics, elderly, or specific comorbidities in relation to AVF infection management 1.Key Recommendations
Employ vascular snare with multiple loops for thrombectomy in chronic organized thrombi of AVFs to achieve high anatomic and clinical success rates (Evidence: Moderate) 1.
Initiate targeted antimicrobial therapy based on blood cultures and sensitivity testing for AVF infections (Evidence: Strong) 1.
Post-thrombectomy anticoagulation may be considered to prevent recurrent thrombosis, though specific dosing guidelines are not provided (Evidence: Expert opinion) 1.References
1 So YH, Mo H, Kim MU, Jung IM. Initial experience of thrombectomy using vascular snare with multiple loops for chronic organized thrombi in patients with thrombosed native hemodialysis fistulas. The journal of vascular access 2025. link