Incidence and management of arterial emboli from hemodialysis graft surgical thrombectomy

PURPOSE: To determine the incidence and significance of arterial emboli resulting from surgical thrombectomy/revision of hemodialysis grafts, This information may help in determining the significance and management of similar emboli resulting from percutaneous hemodialysis graft thrombolysis. PATIENTS AND METHODS: Patients undergoing surgical thrombectomy/revision of clotted hemodialysis grafts are studied with postoperative fistulography per institutional protocol whenever possible, For this retrospective study, all postoperative fistulograms from a 1-year period were reviewed for the presence of arterial emboli, Patients with documented arterial emboli were examined for evidence of hand/digital ischemia; only those patients with signs or symptoms of ischemia were treated, At clinical follow-up, repeated evaluation for hand/digital ischemia was performed. RESULTS: Ninety-one thrombectomy/revision procedures were performed during the study period, Postoperative fistulograms were obtained after 67 of these procedures in 32 patients, One patient complained of hand pain during dialysis prior to acquisition of the postoperative fistulogram. Arterial emboli were documented in eight patients (12%; brachial, n = 3; radial, n = 2; ulnar, n = 2; radial/ulnar, n = 1), The single symptomatic brachial embolus was percutaneously removed; no intervention was undertaken in the remainder, At mean follow-up of 14 months, no patient had developed hand or digital ischemia, Subsequent fistulograms demonstrated partial (n = 2) or complete (n = 2) resolution of the untreated emboli. CONCLUSION: Arterial emboli are a relatively common occurrence with surgical thrombectomy/revision. Conservative management appears to be indicated in asymptomatic patients.