Iftikhar Ahmad MD, Presenter: Nothing to Disclose

Stephan Wicky MD, Abstract Co-Author: Consultant, Johnson & Johnson

Sanjeeva P. Kalva MD, Abstract Co-Author: Research grant, AngioDynamics, Inc

Steven Wu DMD, Abstract Co-Author: Nothing to Disclose

  The purpose of our study was to investigate the incidence of paradoxical embolic complications in patients with PFO who also require hemodialysis access endovascular declot procedures.  

  Study was IRB approved and HIPPA compliant. Subjects were identified via retrospective review of medical records from January 2003 to December 2008. A total of 238 patients (130 male, 55%with mean age 66y range 30-94) and 108 female (45% with mean age 68y range 21-92) underwent 484 Percutaneous Thrombolysis procedures. 218/238 were AV grafts (91.6%) and 20/238 were AV fistulas (8.4%).171/238 patients had echocardiograms available. Of these, 23/171(13.4%) patients were having echocardiogram documented PFO, who underwent a cumulative 50 Percutaneous Thrombolysis procedures. We used chemical Thrombolysis method with tPA 2-4mg injected in clotted access 1 hour before the start of procedure. Inflow and outflow Stenosis were treated with appropriate sized angioplasty balloons. Hospital electronic database was evaluated for any post procedure paradoxical embolic events.

Overall Technical success of the Thrombolysis procedure was 97 %( 471/484). The distribution of these dialysis accesses was as follows. Forearm Radio cephalic (n=, 43, 18.1%), Brachio cephalic (n=42, 17.6%), Brachiobasilic (n=10,4.2%) and Brachio axillary (n=62,26.1%) Brachio anti cubital (n=40, 16.8%), Radio basilic (n=11, 4.1%), Groin SFA-GSV (n= 10, 4.2%) Fistulas (n=20, 8.4%) . Of 23 patients who had documented PFO 8/23 (34%) had left to right, 2/23 (9%) right left and 3/23 (13%) both right to left and left to right shunts. 10/23 (44%) 0f the patients shunt could not be determined. We did not find any paradoxical embolic event in 484 declot procedures performed on 238 patients. 50 procedures were performed on Echo documented 23 PFO patients.  

Percutaneous Thrombolysis of thrombosed arteriovenous fistula/graft for hemodialysis in patients with Patent foramen ovale is safe procedure to perform

Incidence of paradoxical embolism in PFO patients after hemodialysis access declot procedures was unknown. Thrombolysis of  dialysis acess is safe procedure to perform if specifically indicated.

Ahmad, I, Wicky, S, Kalva, S, Wu, S, Paradoxical Embolic Events Associated with Endovascular Declotting Procedure for Thrombosed Hemodialysis AV Fistula or Graft in Patients with Patent Foramen Ovale (PFO).  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9009617.html