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.