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BackTable / VI / Podcast / Episode #117
Successful (and Quick!) Declots for AV Access
with Dr. Neghae Mawla
Interventional Radiologist Christopher Beck talks with Interventional Nephrologist Neghae Mawla about how to perform successful Declot procedures for AV fistulae and grafts, including tips and tricks to make this procedure safe and efficient.
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BackTable, LLC (Producer). (2021, March 22). Ep. 117 – Successful (and Quick!) Declots for AV Access [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Neghae Mawla
Dr. Neghae Mawla is an Interventional Nephrologist with Dallas Nephrology Associates in Texas.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
Synopsis
In this episode, Dr. Neghae Mawla joins Dr. Christopher Beck and Dr. Aaron Fritts to discuss declots for AV access. We discuss what to include in a work up for a declot and how to assess the size of an aneurysm. Dr. Mawla tells us about the cases where he would not perform a declot, and he explains why he might choose to place catheter and dialyze first.
We discuss how to set up the room and how to prepare for the declot procedure. Dr. Mawla shares the reasons why he does not use an IV or ultrasound in pre-op. We explain the differences between using balloon maceration vs rotational thrombectomy device for treating outflow clot. We also touch on the back bleeding technique for declots.
We review the up-down technique, how to use ultrasound to your advantage, and how to avoid overlapping sheaths. We discuss clot burden and why declot procedure length may vary. We explain some different techniques for using multiple sheaths at a time, and Dr. Mawla tells us about troubleshooting during a recalcitrant stenosis. We discuss how to decide when to stent lesions and what follow-up care looks like. Dr. Beck and Dr. Fritts share some of their favorite things they have learned from Dr. Mawla about declots.
Transcript Preview
[Neghae Mawla]
No, so then I'll do a pullback with contrast. I'll just look at the outflow veins to identify the level of the stenosis. With your graft, it's usually at the venous anastomosis. We look at the outflow vein and how much clot burden there is in the outflow vein. Most of the time, it's not that much. It's all in the graft. Once I identify that and I see my thrombus, I stop with my pullback. I'll take the Kumpe out. The way I was always taught was outflow, inflow, polish.
I mean, if you can do that, then you're good. My partner used to always do inflow. He would get up to this point, do the central, sedate, pullback, and then he would get his arterial sheath and then do the inflow. That works, too. I mean, at the end of the day, I don't think it matters how you do it, but it's just different ways of doing it, but I was always taught if there's no outflow and you can't get an outflow, why did you bother with the inflow? I treat the outflow first.
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