The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts

Abstract

Objective: This paper documents our experience using the Cleaner XT device (Argon Medical Devices, Plano, TX, USA) for pharmacomechanical thrombolysis (PMT) of thrombosed haemodialysis arteriovenous grafts (AVG) and fistulas (AVF). Materials and Methods: This was a retrospective case series (n=17) over six months at Singapore General Hospital. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. Results: There were 8 (47%) males and the patients mean age was 66 (± 5.7) years. The mean age of AVF/AVG was 1605 (± 1099) days. All procedures were performed under local anaesthetic. PMT was performed within a mean time of 40 (±34.3) hours from the presentation. Technical, clinical and procedural success was 15/17 (88%). The thrombolysis agents used were tissue plasminogen activator (52.9%) and urokinase (41.2%). Mean primary patency time was 114 (± 116) days, with a 65% 1-month and 47% 3-month primary patency rates. The mean secondary patency time was 155 (±132) days, with 76% one-month and 65% threemonth secondary patency rates, respectively. AVF rupture occurred in 3/17 (18%) cases but did not involve loss of the access circuit. Conclusion: The Cleaner XT device is a safe, minimally invasive endovascular tool for PMT in thrombosed AVF/AVG, with relatively high success and low complication rates.

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts

“…The secondary patency was 84.1% at 6 and 12 months. Huan et al 16 previously reported 1 and 3 month primary patency of 65% and 47% and our results are slightly improved with rates of 78.1% and 58.6% at similar respective time frames. Yang et al 17 retrospectively reviewed 275 percutaneous thrombectomy procedures in thrombosed AVFs.…”

Cleaner XT Rotational Thrombectomy: An Efficacious Endovascular Technique for Salvage of Thrombosed Arteriovenous Access and a 12 Month Outcome Analysis

“…Our patency results were better than those reported by Huan et al who looked at the postintervention primary patency rates in patients who underwent Cleaner XT thrombectomy procedure and reported mean primary patency time of 114 ± 116 days, and 65% 1 month and 47% 3 month primary patency rates. 3 The authors, however, mainly performed thrombolysis, POBA maceration, with Fogarty balloon catheter trawling of clots. Cleaner XT thrombectomy device was only used thereafter as an adjunct if there was residual thrombus.…”

“…1 The Cleaner XT rotational thrombectomy system has been available since 2014, but there is a paucity of literature on its clinical outcome and patency rates. 2,3 This study aims to describe a safe and efficacious yet time-efficient method using Cleaner XT rotational thrombectomy with catheterdirected thrombolysis and balloon angioplasty for the salvage of thrombosed arteriovenous fistulae (AVFs) and arteriovenous grafts (AVGs).…”

Thrombectomy approach for access maintenance in the end stage renal disease population: a narrative review

“…It has a built-in sideport can be used for administration of thrombolytics. Recently, a group in Singapore showed that using the CLEANER device in conjunction with thrombolytics in treating clotted AVG and AVF, they were able to achieve technical and clinical success rates of 88% resulting in 65% 1-month and 47% 3-month primary patency rates ( 51 ). The rotational thrombectomy system can be successfully used to treat patients with aneurysmal AVF.…”