title: Incidence of arterial micro-embolization during percutaneous AngioJet thrombectomy of hemodialysis grafts.
abstract: OBJECTIVE
  This study was designed to investigate the incidence of arterial embolization using a peripheral protection filter device in a series of patients undergoing percutaneous mechanical thrombectomy for the management of thrombosed hemodialysis arteriovenous grafts (AVGs).
  
  
  METHODS
  This prospective, single-center study included all eligible patients presenting during an 18-month period to undergo AVG percutaneous thrombectomy. Inclusion criteria was a recently thrombosed AVG with 2 cm of artery before the next arterial branching. Primary endpoint was the incidence of distal arterial macro- and micro-embolization determined by both digital subtraction angiography and histopathological analysis of the material collected. Secondary endpoints included quantitative measurements of the specimens using a 0+ (no material) to 3+ (maximum load) score.
  
  
  RESULTS
  In total, 42 patients met the study's inclusion criteria. No procedure-related complications or angiographically evident arterial embolization were noted. Macroscopically evident material was present in 47.6% (20/42 filters). Histopathology demonstrated that the embolic material was primary consisted of fibrin conglomerates and platelets (median score: 1.5, confidence interval: 1.0-3.0), whereas inflammatory cells, trapped erythrocytes, extracellular matrix, cholesterol clefts, foam cells, necrotic core, and smooth muscle cells also were detected. Mean total area of embolic material was 5.04 mm(2) (range 0.05-5.21). The mean major axis of the largest particle was 1.83 mm (range 0.29-6.64), whereas 19% (8/42) contained particles with major axis >1 mm and 12% (5/42) with major axis >3 mm.
  
  
  CONCLUSIONS
  In this study, the percentage of arterial micro-embolization was significantly higher than previously reported. However, the detrimental, long-term, clinical relevance remains to be determined.
authors.affiliation: Department of Interventional Radiology, School of Medicine, University of Patras, 26500, Rion, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Koukounas
authors.forename: Dimitris
authors.initials: D
authors.lastname: Karnabatidis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Diamantopoulos
authors.forename: Stavros
authors.initials: S
authors.lastname: Spiliopoulos
authors.forename: George C
authors.initials: GC
authors.lastname: Kagadis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Ravazoula
authors.forename: Stavros
authors.initials: S
authors.lastname: Kakkos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Siablis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000379:methods; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D015331:Cohort Studies; D057505:Embolic Protection Devices; D057510:Endovascular Procedures / Q000295:instrumentation*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D017131:Thrombectomy / Q000009:adverse effects* / Q000295:instrumentation; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology