36870 Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra-graft thrombolysis)

Name of the Procedure:

Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra-graft thrombolysis)

Summary

A percutaneous thrombectomy of an arteriovenous fistula is a minimally invasive procedure designed to remove blood clots from a vascular access point used for hemodialysis. It involves the use of specialized tools to physically extract the clot and/or deliver medications directly into the graft to dissolve it.

Purpose

The procedure addresses blockages in arteriovenous (AV) fistulae or grafts, which can impair the effectiveness of hemodialysis. The primary goal is to restore adequate blood flow through the fistula or graft, ensuring effective dialysis treatment.

Indications

• Reduced or absent blood flow in an arteriovenous fistula or graft detected during hemodialysis.
• Swelling or pain at the access site.
• High venous pressures during dialysis sessions.
• Difficulty cannulating the access site.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medication, especially blood thinners, may be necessary.
• Blood tests and imaging studies (e.g., ultrasound or angiography) to assess the condition of the fistula or graft.

Procedure Description

1. Patient is positioned and local anesthesia or sedation is administered.
2. A catheter is inserted percutaneously through the skin into the affected blood vessel.
3. Mechanical devices are used to break up and extract the clot from the vessel.
4. Intra-graft thrombolysis may be performed by injecting a thrombolytic agent to dissolve remaining clot material.
5. Blood flow is confirmed to be restored using imaging techniques.
6. The catheter is removed, and the entry site is dressed.

Duration

The procedure typically takes 1 to 2 hours.

Setting

It is performed in a hospital's interventional radiology or cardiovascular laboratory.

Personnel

• Interventional radiologist or vascular surgeon
• Nurses
• Technicians and assistants
• Anesthesiologists or nurse anesthetists (if sedation is used)

Risks and Complications

• Bleeding at the puncture site
• Infection
• Vessel damage or perforation
• Reaction to contrast dye used in imaging
• Clot recurrence

Benefits

• Restores effective blood flow for hemodialysis
• Minimally invasive with a shorter recovery time compared to open surgery
• Immediate improvement in dialysis efficacy

Recovery

• Patients are typically observed for a few hours post-procedure.
• Instructions for care of the access site and signs of complications to watch for will be provided.
• Avoid heavy lifting and strenuous activities for a few days.
• Follow-up appointments to assess the function of the fistula or graft.

Alternatives

• Open surgical thrombectomy
• Angioplasty to widen the narrowed portion of the vein
• Stent placement if necessary
• Pros and cons include the invasiveness of the procedure and the recovery time.

Patient Experience

• Mild discomfort or pressure during insertion of the catheter.
• Sedation will help minimize pain and anxiety.
• Post-procedure soreness or bruising at the catheter site.
• Pain management strategies, such as over-the-counter pain relievers, will be advised.