Figure 511

Graft thrombosis due to outflow vein stenosis requiring use of an atherectomy catheter. Thrombectomy of a dialysis access site involves removal of three types of clot. A, The body of a thrombosed access contains a red or purplish thrombus that is often gelatinous. It is easily removed with a balloon-tipped thrombectomy/embolectomy catheter. This photograph also demonstrates the small meniscus of firm, laminar, platelet-rich clot that usually obstructs arterial inflow. On occasion, it is also found at the venous end. This type of clot can be tenacious and may not be removed with thrombolytic therapy or the balloon catheter. A cutdown at the arterial end of the graft may

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