Management of complications of endovascular dialysis access procedures

Endovascular procedures are becoming the standard of care for the management of hemodialysis (HD) vascular access dysfunction. As with any type of medical procedure, these techniques result in procedure-related complications. The expected frequencies are low. The most frequent procedure-related complication seen in association with angioplasty that dictates the need for intervention is tearing of the vein or vein rupture. The clinical significance of this complication is variable, ranging from none to disaster for the access. The difference lies in the severity of the tear. Management depends on the clinical presentation, ranging from symptomatic measures alone to the need to occlude the graft. Since endovascular thrombectomy is a combined procedure including angioplasty, all of the complications of that procedure can occur with this procedure as well. The major unique procedure-related complication requiring interventional therapy is the occurrence of a symptomatic peripheral artery embolus. This complication can generally be managed successfully by mechanical endovascular means. It is essential that the interventionalist be prepared to manage these complications appropriately when they are encountered.