Conclusion
An ever-growing population of patients with ESRD have AVF for
maintenance HD. These fistulas may pose an unrecognized risk for the
development of thrombosis and subsequently an increased risk of venous
thromboembolism. Percutaneous vascular access procedures to relieve a
dysfunctional AVF may be beneficial in the majority of cases. Minimal
venotomy and milking may be an alternative but the clinician needs to be
aware of the possibility of pulmonary embolism following native fistula
thrombectomy.13 Estimating the burden of the thrombus
using a fistulogram may help determine which procedure is best.
Regardless of the procedure, the physician must be abreast with the
risks to the patients with extensive thrombi and diminished
cardiopulmonary reserve.