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A hydrodynamic thrombectomy catheter was prospectively evaluated for the treatment of recently thrombosed vessels. A total of 52 consecutive patients (42 males and 10 females; mean age 64 +/- 15 years) presenting with acute or subacute occlusion of dialysis shunts (n = 25), peripheral bypass (n = 14) or native arteries (n = 15) were treated with the Hydrolyser (Cordis Europa NV, Roden, The Netherlands). Mean occlusion time was 4 days (range 1-17 days) and mean thrombus length 19 +/- 11 cm. The Hydrolyser was effective and fast in removing thrombus, regardless of the thrombus length. No major complications were reported. The immediate procedure success rates were 82, 100, 87 and 79 % for Brescia Cimino, dialysis shunt, native arteries and bypass grafts, respectively. Adjunctive thrombolysis (applied for persistence of residual thrombus or thrombosed distal vessels too small for hydrolytic thrombectomy) was required in 4 % of thrombotic dialysis shunts, in 20 % of native arteries and in 50 % of bypass graft occlusions. On angiographic controls, distal embolizations were reported only in native arteries (13 %) and bypasses (14 %); all were successfully treated percutaneously, except for one case treated by Fogarty balloon. Cumulative primary patency rates were respectively at 6 months 56, 62, 78 and 65 % for each indication. We conclude from this preliminary clinical study that hydrodynamic thrombectomy with a Hydrolyser is a promising technique to treat acute occlusions. This device can reduce complications as well as the time required to remove large amounts of thrombus and the use of expensive thrombolytic drugs.

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A 44 year old woman on hemodialysis presented a sudden cardiorespiratory arrest at the end of an otherwise uneventful dialysis session. It occurred while disconnecting the circuit from her tunneled catheter. She was reanimated and then transferred to the intensive care unit; the endotracheal intubation had been difficult, and she had been severely hypoxic. It was noted that the external venous clamp of the tunneled catheter was broken and the hypothesis of a break during the reanimation process was entertained. The routine chest x-ray postintubation showed that the tip of the catheter was ruptured and visible in one branch of the right pulmonary artery. The catheter was changed over a guide wire, and the broken catheter was sent for analysis to the manufacturer. A selective angiography of the right pulmonary artery was performed with the purpose of removing the fractured catheter tip but was unsuccessful. The patient recovered neurologic function slowly over the next 4 months. The exact etiology of the arrest remains incompletely understood; it is unknown whether it was caused by the catheter tip embolization or if an air embolism occurred.