AngioJet Thrombectomy for Occluded Dialysis Fistulae: Outcome Data

Abstract

This study evaluates AngioJet thrombectomy of occluded autogenous dialysis fistulae and polytetrafluoroethylene (PTFE) grafts in a UK hemodialysis population. Comparison is made with published data of alternative percutaneous thrombectomy methods. All patients with occluded dialysis fistulae who sought care at the Royal Liverpool University Hospital between October 2006 and June 2008 were included in the study. All patients were treated with the AngioJet Rheolytic Thrombectomy Device (Possis, Minneapolis, MN). Demographics, time of occlusion, adjunctive therapies, complications, and follow-up data have been prospectively recorded. A total of 64 thrombectomy procedures were performed in 48 patients. Forty-four autogenous fistulas were treated in 34 patients (19 brachiocephalic, 8 radiocephalic, and 7 transposed brachiobasilic). Twenty PTFE grafts were treated in 14 patients (9 brachioaxillary, 3 brachiocephalic loop grafts, 1 brachiobasilic, and 1 femoro-femoral). The average length of occlusion was 24 cm. Average time to intervention was 4 days. Immediate primary patency was 91%. Primary patency at 1, 3, and 6 months, respectively, was 71%, 60%, and 37%. Secondary patency at 3, 6, and 12 months was 87%, 77%, and 62%, respectively. Angioplasty was carried out in all procedures. Patients required stent insertion in 34 of the 64 thrombectomies to treat angioplasty-resistant stenoses. Complications included a puncture-site hematoma, and three angioplasty-related vein ruptures in one patient, all treated with covered stent grafts. Two cases of distal brachial arterial embolization were successfully treated by thrombosuction. AngioJet thrombectomy in dialysis access occlusion is safe and effective, comparing favorably with other methods.

Yan ağrısı olan bir hastada renal embolinin perkütan tedavisi

“…Complications of endovascular treatment of renal arterial embolism are reported to occur in up to 3% of cases (9) and include distal embolization, arterial rupture, cardiac events and death. The renal parenchyma does not tolerate distal embolization (1,7).…”

Acute Arteriovenous Access Failure: Long-Term Outcomes of Endovascular Salvage and Assessment of Co-Variates Affecting Patency

“…Some authors have reported superior outcomes by using mechanical thrombectomy devices for treatment of thrombosed AVFs [3,8]. In our centre, BM is the first-line thrombectomy method and mechanical or pharmacological methods are used only if BM + PTA fail to achieve satisfactory result.…”

Bradyarrhythmias During Rheolytic Pharmacomechanical Thrombectomy for Deep Vein Thrombosis

“…3,[8][9][10] Although large numbers of patients have undergone thrombectomy of arteriovenous fistulae with the device, the incidence of clinically significant bradyarrhythmias is poorly characterized. 4,5,11 In lower extremity arterial and bypass graft use of the device, there was a 3.5% incidence of arrhythmias noted by Kasirajan et al 12 The location of the device and the mechanism by which these arrhythmias occur in the setting of peripheral use were not described. There is very little data exploring the incidence or mechanisms of bradyarrhythmias with venous use of the AngioJet.…”