Continuous Aspiration Mechanical Thrombectomy for Treatment of Thrombosed Hemodialysis ReliableOutflow Grafts

Osman Ahmed; Mohamad Omar Hadied; Sreekumar Madassery; Merve Ozen; Patrick Tran; Adolfo E. Lizardo; Jordan C. Tasse; Ulku Cenk Turba; Bulent Arslan

doi:10.4103/AJIR.AJIR_9_19

The Arab Journal of Interventional Radiology, Table of Contents

CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2020; 4(01): 21-26
DOI: 10.4103/AJIR.AJIR_9_19

Original Article

Continuous Aspiration Mechanical Thrombectomy for Treatment of Thrombosed Hemodialysis ReliableOutflow Grafts

Authors

Osman Ahmed

Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL
Mohamad Omar Hadied

Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
Sreekumar Madassery

Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL
Merve Ozen

Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL
Patrick Tran

Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL
Adolfo E. Lizardo

Department of Radiology, South Medical Clinic and Hospital, National Institute of Cancer, Mexico City, Mexico
Jordan C. Tasse

Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL
Ulku Cenk Turba

Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL
Bulent Arslan

Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL

Abstract

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Aims: To determine the safety and feasibility of continuous aspiration mechanical thrombectomy (CAT) for restoring patency to thrombosed hemodialysis reliable outflow (HeRO) arteriovenous grafts. Subjects and Methods: Between December 2016 and August 2017, eleven consecutive patients (average age 63, range 39–80 years) with thrombosed HeRO grafts underwent percutaneous thrombectomy procedures (n = 21) using the Penumbra Indigo^® CAT 8 or CAT D (Alameda, CA, USA) thrombectomy catheter as the primary device to clear the venous outflow tract before removing the arterial plug with a compliant balloon. A total of 21 hemodialysis declot procedures using CAT were documented and analyzed. Average procedure length and fluoroscopy time, length of thrombus cleared, blood loss, complications, and time between thrombectomy procedures were recorded and compared to the same patient's previous three thrombectomy procedures. Results: All procedures were technically successful (100%) at restoring graft patency; however, reocclusion within 5 days occurred in four (19.0%) cases. Three (14.3%) interventions required additional balloon maceration or sweep to clear the venous outflow following thrombectomy. Average thrombus length treated by suction thrombectomy measured 23.15 cm (range 2.2–65 cm). Average blood loss was 162.6 mL (range 50–250 mL). No procedure-related complications were recorded. The average procedure length and fluoroscopy time using suction thrombectomy was 74.7 and 14.2 min, respectively, compared with 82.0 and 14.0 min, respectively, in the previous thrombectomy procedures using standard methods (P > 0.05). Seventeen (81%) HeRO grafts treated by CAT presented with rethrombosis at a mean of 42.47 days (range 1–208 days, median 22 days, standard deviation [SD] 28.2 days) since CAT procedure compared to patients treated by conventional methods who presented for rethrombosis at a mean of 55.33 days (range 1–321 days, median 34 days, SD 43.1 days) since standard thrombectomy – no statically significant difference (P > 0.05). Conclusion: CAT is a safe and feasible method for removing thrombus and restoring patency to thrombosed HeRO grafts. Further studies are required to elucidate the advantages of CAT over standard thrombectomy techniques.

Endovascular - hemodialysis - suction - thrombectomy

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References

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