What to Do When Hemodialysis Patients Develop Blood Clots in Vascular Access

For patients undergoing hemodialysis, the formation of blood clots in vascular access sites—such as arteriovenous (AV) fistulas or grafts—is a serious and relatively common complication. When a thrombosis occurs, prompt medical intervention is crucial to restore blood flow and maintain effective dialysis treatment.

Immediate Treatment Options for Vascular Access Thrombosis

Thrombolysis, or clot-dissolving therapy, is often the first-line approach. This involves administering medications such as tissue plasminogen activator (tPA) directly into the clot to break it down and restore patency. In many cases, this minimally invasive method can effectively reopen the blocked vessel without the need for surgery.

If thrombolysis fails or isn't suitable due to the size or location of the clot, surgical thrombectomy may be required. During this procedure, a vascular surgeon removes the clot manually to reestablish blood flow. While more invasive, it can be highly effective, especially in acute cases where time is critical.

When Revascularization Isn't Possible: Creating a New Access

In situations where the existing vascular access cannot be salvaged despite thrombolysis or surgery, clinicians often recommend constructing a new arteriovenous fistula. Since repeated clotting can damage veins over time, selecting a new site with healthy vasculature becomes essential for long-term dialysis success.

Sudden Clot Formation After Dialysis: Causes and Early Interventions

A common clinical scenario involves patients developing sudden AV fistula occlusion shortly after completing a four-hour dialysis session. This is frequently linked to hypotension or excessive fluid removal during treatment, leading to reduced blood volume and sluggish circulation in the access site.

Manual Recanalization Within the Golden Window

When detected early—ideally within six hours of clot formation—some blockages can be reversed through manual techniques such as gentle fist massage. This method helps disrupt small clots and promote reflow, particularly when combined with anticoagulant therapy. However, this should only be performed under medical supervision to avoid complications like embolism or vessel injury.

Preventive strategies, including close monitoring of blood pressure, optimizing dry weight targets, and regular vascular access surveillance, play a vital role in reducing the risk of recurrent thrombosis. Educating patients on self-checking their fistula's thrill and bruit can also lead to earlier detection and better outcomes.