Paradoxical Embolism after Declotting of Hemodialysis Fistulae/Grafts in Patients with Patent Foramen Ovale |
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Authors: | Steven Wu Iftikhar Ahmad Sohail Qayyum Stephan Wicky Sanjeeva P Kalva |
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Institution: | *Section of Interventional Nephrology, Division of Nephrology, Department of Medicine, and ;†Division of Vascular Imaging & Interventions, Department of Imaging, Massachusetts General Hospital, and ;Departments of ‡Medicine and ;§Radiology, Harvard Medical School, Boston, Massachusetts |
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Abstract: | SummaryBackground and objectivesThe safety of percutaneous endovascular declotting procedures for thrombosed hemodialysis fistulae/grafts is well described in the general population; however, its safety in the presence of a patent foramen ovale (PFO) is not known. The objective of this study is to assess the incidence of symptomatic paradoxical embolic events associated with declotting procedure of thrombosed arteriovenous (AV) graft or fistula in patients with documented PFO.Design, setting, participants, & measurementsThis was a retrospective study in a hospital-based, academic practice. It included 23 patients (10 men; mean age, 65) with PFO and thrombosed hemodialysis graft/fistula who underwent a standardized declotting procedure with 2 mg of Alteplase and balloon thrombectomy. Twenty patients (87%) had AV grafts, and three (13%) had AV fistulae. The PFO shunt was right to left in two (9%), left to right in eight (34%), and bidirectional in ten (44%). The shunt direction was not specified in three patients (13%). The technical success of the declotting procedure and the frequency of clinically manifested paradoxical embolic events in this patient population were calculated.ResultsFifty declotting procedures were performed on 23 patients with a technical success rate of 96% (48 of 50, 96%). No symptomatic paradoxical embolic events were found in any of the 23 patients with PFO.ConclusionsSymptomatic paradoxical embolic events after percutaneous endovascular declotting procedures of thrombosed AV grafts and fistulae in patients with documented PFO are rare. This procedure appears to be safe in patients with a PFO. |
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