title: Endovascular Revascularization of Hemodialysis Thrombosed Grafts with the Hydrodynamic Thrombectomy Catheter. Our 7-Year Experience.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of the hydrodynamic thrombectomy catheter (AngioJet DVX) in the salvage of thrombosed hemodialysis vascular grafts.
  
  
  METHODS
  A retrospective study was designed, including all patients with occluded arteriovenous grafts treated with the AngioJet system between 2007 and 2014 in our institution. Outcomes included technical success, clinical success, complications, and primary and secondary patencies. Procedural success was defined as angiographic confirmation of flow restoration, the presence of a pulsatile thrill along the graft, and successful resumption of at least one hemodialysis session. Primary and secondary patencies after first AVG thrombectomy were calculated with Kaplan-Meier curves. Cox regression was used to determine prognostic factors of primary patency after every thrombectomy episode.
  
  
  RESULTS
  A total of 149 thrombectomies were performed in 68 grafts. After thrombectomy, endovascular treatment of one or more stenosis was performed in all cases. Technical success was 93% and clinical success was 86%. Complications occurred in 7 thrombectomies, most of them were minor except for one anastomosis rupture requiring surgery. Primary and secondary patencies were 52, 41, and 23 and 76, 68, and 57% at 3, 6 and 12 months, respectively. Independent prognostic factors of poor patency after every thrombectomy episode were the presence of residual thrombus (OR 1.831, P = 0.008) and time from last thrombosis (less than 1 month; and OR 7.116, P < 0.001).
  
  
  CONCLUSIONS
  Percutaneous mechanical thrombectomy with AngioJet is a safe technique with a high-clinical success rate. The presence of residual thrombus after thrombectomy and early re-occlusions are related to poorer results.
authors.affiliation: Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain. pbermude@clinic.ub.es.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Bermudez
authors.affiliation: Vascular Access Unit, Nephrologic and Urologic Diseases Clinical Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Nestor
authors.initials: N
authors.lastname: Fontseré
authors.affiliation: Cardiovascular Diseases Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Gaspar
authors.initials: G
authors.lastname: Mestres
authors.affiliation: Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: García-Gámez
authors.affiliation: Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Barrufet
authors.affiliation: Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Burrel
authors.affiliation: Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gilabert
authors.affiliation: Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gómez
authors.affiliation: Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Macho
mesh_terms: D000368:Aged; D057785:Catheters; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Endovascular thrombectomy; Hemodialysis vascular grafts; Hydrodynamic thrombectomy