case_images: PMC4349238_01
case_images: Fistulogram images of radio-cephalic fistula. a: Fistulogram unable to demonstrate anastomosis with a clotted radio-cephalic fistula and no flow of contrast material past the point of the stenosis (arrow indicating stenosis). b: Post pharmacomechanical thrombolysis in radiology suite demonstrating poor flow through the same fistula with heavy clot burden. c: Fistulogram one week later with repeat angioplasty of existing stenosis, after hemodialysis tPA infusion. No clot was demonstrated. Residual stenosis indicated by arrows.
case_images: 40697_2015_35_Fig3_HTML.jpg
case_images: PMC4349238_01_40697_2015_35_Fig3_HTML.jpg
case_images: Fig3
case_images: He underwent an urgent fistulogram (Figure 3a) that demonstrated a completely occluded fistula. Partial recovery of flow was achieved but heavy residual clot burden was seen (Figure 3b). A fistulogram one week later demonstrated no clot but there was evidence of residual stenosis still present (Figure 3c).
case_images: Fistulogram and ultrasound images of radio-cephalic fistula. a: Fistulogram after attempted angioplasty and before tPA infusion. Clot is seen in the venous aneurysm. b: Ultrasound demonstrates a persistent large clot in the venous aneurysm. c: Fistulogram of venous aneurysm one week after tPA infusion, demonstrating significant decrease in clot burden.
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case_images: PMC4349238_01_40697_2015_35_Fig4_HTML.jpg
case_images: Fig4
case_images: She underwent an urgent fistulogram and angioplasty but the procedure was deemed unsuccessful since adequate flow was not established and there was evidence of large residual clot burden (Figure 4a). An ultrasound (Figure 4b) showed a large clot in the venous aneurysm. Significant reduction of clot burden was demonstrated a week later with a repeat fistulogram (Figure 4c).
case_images: PMC4349238_02
case_images: Fistulogram and ultrasound images of brachio-cephalic fistula. a: Fistulogram of Brachio-Cephalic AVF demonstrating a stenosis mid humerus (arrow). b: Doppler flow ultrasound of the AVF with large residual clot. c: Repeat ultrasound after tPA infusions resulted in decrease of clot burden.
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case_images: PMC4349238_02_40697_2015_35_Fig5_HTML.jpg
case_images: Fig5
case_images: A repeat fistulogram indicated persistent stenosis mid-humerus (Figure 5a) and was treated with angioplasty. A follow up ultrasound a week later showed residual clot (Figure 5b). Decrease of clot burden was evident on a repeat ultrasound (Figure 5c).