Aspirex Thrombectomy in Occluded Dialysis Access: A Retrospective Study.
OBJECTIVE
This study is the first to present the outcomes of the Straub Aspirex device for the salvage of occluded renal dialysis access fistulae.


METHODS
This is a retrospective study, using data from the Renal Unit and Radiology Department database. It included all the patients between 2010 and 2014 who underwent percutaneous mechanical thrombectomy (PMT) treated by JD. Aspirex is an over-the-wire, 6-10 French catheter within which is a rapidly rotating helix which draws thrombus into a window near the tip which it then macerates and removes. Access survival was assessed using the Kaplan-Meier method, and multi-variant analysis was performed using the Cox proportional hazards model. Significance was considered if p < 0.05.


RESULTS
A total of 27 procedures were performed for 19 patients. 13 had autologous arterio-venous fistulae, and 14 had synthetic (PTFE) arterio-venous grafts. 15 were males, 4 females. 100 % of the patients successfully had a channel of thrombus removed. This resulted in an 81.5 % initial clinical success, with primary patency rates of 53.6, 44.3 and 33 % by days 30, 90 and 480, respectively, without significant difference of any analysed covariates. No major complication (pulmonary embolus, paradoxical cerebral infarction, limb ischaemia or significant haemorrhage) occurred.


CONCLUSIONS
Aspirex has rates of patency and complication similar to other PMT devices. No covariant studied affected outcome.
Department of Radiology, New Cross Hospital, Wolverhampton, West Midlands, WV10 0QP, UK. Jules.Dyer@nhs.net.
Jules
J
Dyer
ST1 Radiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Joao
J
Rosa
University of Birmingham, Birmingham, West Midlands, UK.
Menka
M
Chachlani
Department of Radiology, New Cross Hospital, Wolverhampton, West Midlands, WV10 0QP, UK.
Johann
J
Nicholas
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D013396:Suction / Q000295:instrumentation*; D017131:Thrombectomy / Q000295:instrumentation*; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome
Access; Aspirex; Dialysis; Fistula; Salvage; Thrombectomy