10 doctors weighed in:
How do physicians de-clot an av fistula for dialysis patients?
10 doctors weighed in

Dr. Laura Pak
Surgery - Vascular
4 doctors agree
In brief: Open or endo
It can be done with tpa (alteplase) (a high-potency medication to dissolve blood clot) and a rotor-rooter device inserted through a needle stick in the access.
I tend to make a small incision to remove the clot with a balloon catheter, then do an angioplasty on the area of stenosis (narrowing) which you usually find in the vein or graft.

In brief: Open or endo
It can be done with tpa (alteplase) (a high-potency medication to dissolve blood clot) and a rotor-rooter device inserted through a needle stick in the access.
I tend to make a small incision to remove the clot with a balloon catheter, then do an angioplasty on the area of stenosis (narrowing) which you usually find in the vein or graft.
Dr. Laura Pak
Dr. Laura Pak
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Dr. Eric Chen
Radiology
3 doctors agree
In brief: Declot
A declot is a procedure to remove clot from a dialysis access and regain function of that access.
First, a catheter is placed into the fistula or graft. Next, the physician will use either mechanical (think roto-rooter) or pharmacological (clot dissolver) means to remove the clot (or both). Then, the physician will treat the cause of the clot, which is usually a narrowing or the access.

In brief: Declot
A declot is a procedure to remove clot from a dialysis access and regain function of that access.
First, a catheter is placed into the fistula or graft. Next, the physician will use either mechanical (think roto-rooter) or pharmacological (clot dissolver) means to remove the clot (or both). Then, the physician will treat the cause of the clot, which is usually a narrowing or the access.
Dr. Eric Chen
Dr. Eric Chen
Thank
Dr. Rodeen Rahbar
Surgery - Vascular
1 doctor agrees
In brief: Two methods
There are two methods: mechanical or chemical.
Occasionally both methods are used. In general, the doctor accesses the av graft or fistula with a needle and places a tube into the graft. He then uses wires and catheters to cross the clot and inject clot busting meds. There are devices he can use that also break up clot. Or, he can open the graft and use special balloons to pull clot out.

In brief: Two methods
There are two methods: mechanical or chemical.
Occasionally both methods are used. In general, the doctor accesses the av graft or fistula with a needle and places a tube into the graft. He then uses wires and catheters to cross the clot and inject clot busting meds. There are devices he can use that also break up clot. Or, he can open the graft and use special balloons to pull clot out.
Dr. Rodeen Rahbar
Dr. Rodeen Rahbar
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Dr. Michael Korona
Radiology - Interventional
1 doctor agrees
In brief: Many ways
Dissolve or grind up clot.
Can suck clot out. Then treat underlying problem with stent.

In brief: Many ways
Dissolve or grind up clot.
Can suck clot out. Then treat underlying problem with stent.
Dr. Michael Korona
Dr. Michael Korona
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Dr. Alan Koslow
Surgery - Vascular
1 doctor agrees
In brief: Thrombolysis or surg
Most can be declotted with clot busters.
Some need a surgical thrombectomy.

In brief: Thrombolysis or surg
Most can be declotted with clot busters.
Some need a surgical thrombectomy.
Dr. Alan Koslow
Dr. Alan Koslow
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