Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: follow-up study.
OBJECTIVE
To evaluate the feasibility, efficacy, and safety of mechanical thrombectomy of occluded dialysis access with use of a rotating mini-pigtail catheter.


METHODS
Thrombus was fragmented by mechanical action of the rotating pigtail tip (5-mm diameter), while the guide wire exited a sidehole at the pigtail curvature and served as a fixed rotation axis. Twenty-six procedures were performed in 22 patients (12 men, 10 women; mean age, 55.5 years). Native fistulas were treated in 15 instances, polytetrafluoroethylene (PTFE) grafts were treated in 11 instances. Average occlusion time was 20 hours +/- 13 (range, 5-46 hours), average occlusion length was 25.6 cm +/- 10.1 (range, 6-45 cm). Thrombus fragmentation was followed by balloon angioplasty of underlying stenoses.


RESULTS
In all 26 procedures, the dialysis access was successfully declotted with subsequent dialysis using the access (clinical success rate, 100%). Handling of the mini-pigtail catheter was simple and rapid, regardless of whether a graft or a native fistula was treated. Average duration of the intervention was 118 minutes +/- 30. Mean primary patency was 165 days +/- 167. Primary patency rate was 82% at 30 days, 65% at 3 months, and 47% at 6 months. There was no evidence of complications due to the thrombus fragmentation procedure.


CONCLUSIONS
The results suggest that declotting of occluded dialysis grafts and fistulas with the mini-pigtail catheter is as effective and safe as other more established percutaneous therapies. It may serve as an easy-to-handle, low-budget alternative to current thrombectomy devices.
Schmitz-Rode
T
T
Department of Diagnostic Radiology, University of Technology, Uinversitätsklinikum, Aachen, Germany. smiro@rad.rwth-aachen.de
Wildberger
J E
JE
Hübner
D
D
Wein
B
B
Schürmann
K
K
Günther
R W
RW
D000328:Adult; D000368:Aged; D000792:Angiography; D001672:Biocompatible Materials; D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011475:Prosthesis Failure; D006435:Renal Dialysis; D017131:Thrombectomy / Q000295:instrumentation*; D014654:Vascular Patency
D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene