Mechanical Thromboaspiration of Acute Thrombosis of Dialysis Arteriovenous Fistulae and Grafts using the Penumbra Indigo System: Preliminary Results from a Single Center Experience

Background: Thrombosis of vascular accesses is most often due to venous anastomotic outflow stenosis or obstruction. Many percutaneous mechanical devices have been developed to eliminate the clot. Their clinical success rates are usually between 71% and 100%, with low incidence of serious complications. The indigo mechanical thrombectomy system (Penumbra, inc) consists of vacuum-assisted thrombectomy, which enables continuous thrombus aspiration. Preliminary results with this device in treatment of thrombosed vascular access have been recently reported in literature. We want to report the preliminary results of our early experience with Indigo System CAT8, and the new cat d, in the treatment of acute thrombosed av f and avg. Method(s): Between November 2017 and July 2018, 5 patients with acutely thrombosed dialysis fistulae were treated. All procedures were performed within 48 hours of the occurrence of thrombosis. Patients (average age, 71 y; age range, 57–86 y; 3 men and 2 women) were treated with the indigo system. Result(s): Technical success was 80% (4 of 5 patients). Clinical success was 80% (4 of 5 patients); 1 patient had a thrombosed dialysis fistula 24 hours after declotting. No technical or device-related complications were reported. Adjunctive procedures included PTA (60%) and stent graft deployment (40%; 2 of 5 patients). Mean FU was 163 days (range 59–301). Primary patency at one-month was 80%. One patient had a second aspiration for recurrent thrombosis of the fistula at 37 days from the first procedure, leading to a 3-month primary patency of 60% and a secondary patency of 80%. Conclusion(s): Our preliminary experience confirms the safety and the efficacy of mechanical thrombo-aspiration with indigo system in the treatment of thrombosed dialysis AVF and/or AVG. Our results in terms of clinical success and patency at 3-month are in line with what reported by vascular guidelines.

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Artikel online veröffentlicht:
11. Mai 2021