Pharmacomechanical thrombectomy with the Castañeda brush catheter in thrombosed hemodialysis grafts and native fistulas.
OBJECTIVE
To evaluate the safety and efficacy of the Castañeda brush catheter in the treatment of thrombosed hemodialysis fistulas and grafts.


METHODS
Twenty-six revascularization procedures with the Castañeda brush catheter combined with urokinase were retrospectively analyzed in 21 patients (mean age, 69 years; range, 35-87 y). Hemodialysis shunts were native arteriovenous (AV) fistulas (n=15; 16 procedures) or polytetrafluoroethylene grafts (n=6; 10 procedures). Major outcomes included procedure time, anatomic and clinical success rates, complication rate, and primary, primary assisted, and secondary patency.


RESULTS
In 26 procedures, the brush catheter was used in combination with a mean dose of 239,792 IU urokinase (range, 60,000-300,000 IU). Additional angioplasty was performed in all procedures; five procedures (19%) required additional stent implantation. Mean procedure time was 99.2 minutes (range, 49-261 min). Anatomic and clinical success rates were 100% and 96.2%, respectively. Two minor complications (8%) occurred, neither of which was device-related: one case of extravasation treated by balloon tamponade and one hematoma at the distal puncture site without the need for surgery or transfusion. Primary patency rates were 87%, 62%, and 50% at 3, 6, and 12 months, respectively, for AV fistulas, and 50%, 33%, and 17%, respectively, for grafts. Assisted primary patency rates were 93%, 77%, and 70% at 3, 6, and 12 months, respectively, for AV fistulas, and 50%, 33%, and 17%, respectively, for grafts. At 3, 6, and 12 months, secondary patency rates were 93%, 85%, and 80%, respectively, for AV fistulas, and 83%, 67%, and 50%, respectively, for grafts.


CONCLUSIONS
The Castañeda brush catheter is a safe and effective pharmacomechanical thrombectomy device for the treatment of thrombosed hemodialysis grafts and native fistulas.
Heye
Sam
S
Department of Radiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. sam.heye@uz.kuleuven.ac.be
Van Kerkhove
Filip
F
Claes
Kathleen
K
Maleux
Geert
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D004343:Drug Implants / Q000008:administration & dosage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D016157:Vascular Fistula / Q000150:complications*
D004343:Drug Implants; D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator