Percutaneous balloon-assisted aspiration thrombectomy of clotted hemodialysis access grafts.
OBJECTIVE
To present experience with percutaneous balloon-assisted aspiration thrombectomy (BAT) for the treatment of patients with clotted hemodialysis access grafts.


METHODS
BAT was performed with use of 7-F intravascular sheaths and a Fogarty balloon catheter. It was tested with an in vitro flow-circuit model. Twenty consecutive BAT procedures were performed in 15 patients with clotted grafts. The balloon catheter was advanced through the sheath to the arterial anastomosis. The balloon was inflated and withdrawn while suction was applied from the sideport to recover thrombus. The procedure was repeated for the venous limb. BAT was used alone in 12 procedures and in combination with urokinase in eight procedures.


RESULTS
Almost complete thrombectomy was achieved in all tubes (in vitro), with very low venous and arterial embolic fractions. Technical success (restored graft thrill and almost complete thrombectomy) was achieved in 18 cases (90%). Clinical success (patency after 1 week of dialysis) was achieved in 17 cases (85%).


CONCLUSIONS
Percutaneous BAT is feasible in recently clotted dialysis grafts.
Sharafuddin
M J
MJ
Department of Radiology, St Louis University Health Sciences Center, Mo, USA.
Kadir
S
S
Joshi
S J
SJ
Parr
D
D
D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D002404:Catheterization / Q000379:methods*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis; D013396:Suction / Q000379:methods*; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000601:surgery* / Q000628:therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency
D011138:Polytetrafluoroethylene; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator