Middle aged male with high flow megafistula and successful CRT is six months out from ligation and removal of the fistula. 1 cm feeding artery. Placed on aspirin only. Comes to ER yesterday with painful arm tender over thrombosed brachial artery, hand warm with transient tingling. Improves a bit after 12 hours argatroban (hx HIT) infusion with tentative plan to convert to eliquis and plavix.
I have seen a half dozen of these with an extensive history of flow reductions and megafistula takedowns. Have referred a few to "real" vascular surgeons, but thrombectomy never recommended. Is there any consensus on how to manage the risk immediately at the time of ligation, or to handle the complication?
I know this group has seen this - Thierry Porchet responded to my last night post on KA.
Marc Webb, MD FACS, Detroit - 734-502-1239
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