Percutaneous management of acutely thrombosed hemodialysis grafts: the double balloon occlusion technique.
OBJECTIVE
The aim of this article is to introduce a new technique, named the "double balloon occlusion technique" (DBOT), for the salvage of acutely thrombosed grafts and to demonstrate its safety and efficacy.


BACKGROUND
Acute thrombosis is recognized as the most common factor of acute graft failures. A suitably percutaneous technique should be devised to remove thrombi safely and effectively. Care should also be taken to prevent possible thromboembolic complications during procedures. Mainly composed of two balloons, the percutaneous DBOT has been developed to meet the clinical needs.


METHODS
Thirty-two patients with graft failures undergoing the DBOT were recruited between May 2007 and May 2008. The DBOT is itemized in the text and a practical case undergoing successful DBOT is also demonstrated.


RESULTS
Of the 32 DBOT treatments, the procedural success rate was 100% (32/32). The clinical success rate was 94% (30/32). One complicated case with severe hematoma resulting from a balloon-induced graft rupture received surgery, although the graft outflow restored. The mean procedure time was 92 minutes. Three patients died and two patients were lost within the 3-month follow-up. The 3-month graft patency rate was 70% (19/27).


CONCLUSIONS
The DBOT has the potential to be operated safely and effectively. Preliminary results had high success rates and patency rates. With basic devices, it may serve as an option to rescue thrombosed grafts. More data are needed to identify its clinical role.
Lai
Chi-Cheng
CC
Cardiovascular Center, Kaohsiung Veterans General Hospital, Taiwan 813-62, Republic of China.
Kang
Pei-Leun
PL
Tsai
Han-Lin
HL
Mar
Guang-Yuan
GY
Liu
Chun-Peng
CP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015641:Radiography, Interventional; D006435:Renal Dialysis; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency