Mechanical thrombectomy of occluded hemodialysis native fistulas and grafts using a hydrodynamic thrombectomy catheter: preliminary experience.
The purpose of this study was to evaluate the efficacy and safety of a new hydrodynamic percutaneous thrombectomy catheter in the treatment of thrombosed hemodialysis fistulas and grafts. Twenty-two patients (median age: 47 years; range: 31-79 years) underwent mechanical thrombectomy for thrombosed hemodialysis fistulas or polytetrafluoroethylene (PTFE) grafts. In all cases, an Oasis hydrodynamic catheter was used. Five patients had native fistulas and 17 had PTFE grafts. Six patients required repeat procedures. All patients with native fistulas and 15 of the 17 with PTFE grafts also underwent angioplasty of the venous limb following the thrombectomy. Major outcome measures included technical success, clinical success, primary and secondary patency, and complication rates. Twenty-eight procedures were performed in total. The technical success rate was 100% and 90% and clinical success was 86% and 76% for native fistulas and grafts, respectively. The primary patency at 6 months was 50% and 59% for fistulas and grafts, respectively, and the secondary patency at 6 months was 75% and 70% for fistulas and grafts, respectively. Two patients died of unrelated causes during the follow-up period. The Oasis catheter is an effective mechanical device for the percutaneous treatment of thrombosed hemodialysis access. Our initial success rate showed that the technique is safe in the treatment of both native fistulas and grafts.
Sahni
Vikram
V
Department of Radiology, Barts and The London NHS Trust, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK. vassahni@hotmail.com
Kaniyur
Sunil
S
Malhotra
Anmol
A
Fan
Stanley
S
Blakeney
Charles
C
Fotheringham
Tim
T
Sobeh
Mohammed
M
Matson
Matthew
M
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D005402:Fistula / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013927:Thrombosis / Q000601:surgery; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology