Journet Julien, Bui Huu Tri, Capdevila Clement, Lavaud Sylvie, Hadj Henni Amine, Clément Claude, Rieu Philippe, Long Anne
Service de médecine vasculaire, hôpital Robert-Debré, CHU de Reims, rue du Professeur-Kochman, 51092 Reims cedex, France.
Nephrol Ther. 2010 Apr;6(2):121-4. doi: 10.1016/j.nephro.2009.12.002. Epub 2010 Feb 23.
Surgical removal of a hemodialysis access after thrombosis is generally not performed as it remains clinically well tolerated. However, it may be the source of distal embolization. We report the case of a 43-year-old patient, kidney recipient, who presented with digital ischemia of the right hand. He had a forearm arteriovenous fistula at the right wrist which thrombosed 5 years ago. Digital ischemia was due to thrombus formation at the anastomotic site and migration into the downstream arterial bed. Heparine was initiated together with antiplatelet treatment. The ischemia resolved after a few days, no recidive was observed. Surgical ligation of the arteriovenous fistula was rapidly performed and antiplatelet treatment was maintained after surgery. After a follow-up of 6 months, the patient remained asymptomatic without new embolization. This observation underlines the necessity of clinical monitoring after access thrombosis and preventive surgical ligation might be discussed when the risk of distal embolization is high.
