Dialysis Shunt Thrombectomy Utilizing a Rotational Thrombectomy Device in Patients with Pseudoaneurysms

Aims: To assess the safety and efficacy of dialysis shunt thrombectomy utilizing a rotational thrombectomy device in patients with pseudoaneurysms refractory to declot by conventional treatments. Methods: Between July 2016 and August 2019, 34 dialysis shunt thrombectomies were retrospectively examined in 29 individual patients. All patients presented with pseudoaneurysms and clotted accesses that were refractory to angioplasty balloon sweeps (“push–pull”) to restore patency. The Cleaner^® rotational thrombectomy device was used as a bail-out in an attempt to restore patency to the clotted shunt. Procedure success, complications, primary patency, primary-assisted patency, secondary patency, average number of shunt pseudoaneurysms, and average pseudoaneurysm size were documented and analyzed. Results: Thirty-three of the 34 (97%) thrombectomies were successful in restoring patency and facilitating same-day hemodialysis. An average of 1.5 pseudoaneurysms were present per patient (range 1–3 pseudoaneurysms, standard deviation [SD] 0.65 pseudoaneurysms), with an average size of 15.0 mm (range 9.4–31.1 mm, SD 4.87 mm). Postprocedural complications occurred in 14.7% of the cases, none of which were definitively device related. Primary patency to the time of data collection was achieved in 29% of the cases, and the average primary patency for these cases was 124.5 days (range 10–946 days, SD 186.9 days). The average primary-assisted patency was 126.8 days (range 1–564 days, SD 169.8 days). Dialysis accesses were eventually abandoned or surgically revised in ten instances, resulting in an average secondary patency of 157.5 days (range 6–712 days, SD 257 days). Conclusions: In patients with pseudoaneurysms, rotational thrombectomy with the Cleaner^® device appeared to be a safe and effective option for restoring patency to thrombosed dialysis accesses refractory to standard push–pull techniques with angioplasty balloons.

Dialysis intervention - patency - pseudoaneurysm - shunt - thrombectomy

Publication History

Received: 02 April 2020
Received: 25 April 2020

Accepted: 14 May 2020

Article published online:
26 March 2021

• References

• 1 Zaleski G. Declotting, maintenance, and avoiding procedural complications of native arteriovenous fistulae. Semin Intervent Radiol 2004;21:83-93.
• 2 Funaki B. Problematic declots: Complications and irritations. Semin Intervent Radiol 2004;21:69-75.
• 3 Quencer KB, Rahmi O. Hemodialysis access thrombosis. Cardiovasc Diagn Ther 2017; 7 Suppl 3:S299-308.
• 4 Mudoni A, Cornacchiari M, Gallieni M, Guastoni C, McGrogan D, Logias F, et al. Aneurysms and pseudoaneurysms in dialysis access. Clin Kidney J 2015;8:363-7.
• 5 Ahn SY, So YH, Choi YH, Jung IM, Chung JK. Endovascular recanalization of a thrombosed native arteriovenous fistula complicated with an aneurysm: Technical aspects and outcomes. Korean J Radiol 2015;16:349-56.
• 6 Hedin U, Engström J, Roy J. Endovascular treatment of true and false aneurysms in hemodialysis access. J Cardiovasc Surg (Torino) 2015;56:599-605.
• 7 Inston N, Mistry H, Gilbert J, Kingsmore D, Raza Z, Tozzi M, et al. Aneurysms in vascular access: State of the art and future developments. J Vasc Access 2017;18:464-72.
• 8 Marcelin C, D'Souza S, Le Bras Y, Petitpierre F, Grenier N, van den Berg JC, et al. Mechanical thrombectomy in acute thrombosis of dialysis arteriovenous fistulae and grafts using a vacuum-assisted thrombectomy catheter: A multicenter study. J Vasc Interv Radiol 2018;29:993-7.
• 9 US Device Guide/Mechanical Thrombectomy/Thrombolysis. Endovascular Today. Available from: https://evtoday.com/device-guide/us/mechanical-thrombectomyt hrombolysis. [Last access ed on 2020 Jun 07].
• 10 Bozkurt A, Kırbaş İ, Kösehan D, Demirçelik B, Nazlı Y. Pharmacomechanical thrombectomy in the management of deep vein thrombosis using the cleaner device: An initial single-center experience. Ann Vasc Surg 2015;29:670-4.
• 11 Yuksel A, Tuydes O. Midterm outcomes of pharmacomechanical thrombectomy in the treatment of lower extremity deep vein thrombosis with a rotational thrombectomy device. Vasc Endovascular Surg 2017;51:301-6.
• 12 Köksoy C, Yilmaz MF, Başbuǧ HS, Calik ES, Erkut B, Kaygın MA, et al. Pharmacomechanical thrombolysis of symptomatic acute and subacute deep vein thrombosis with a rotational thrombectomy device. J Vasc Interv Radiol 2014;25:1895-900.
• 13 Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, et al. Quality improvement guidelines for percutaneous image-guided management of the thrombosed or dysfunctional dialysis circuit. J Vasc Interv Radiol 2016;27:1518-30.
• 14 CLEANER Rotational Thrombectomy System. Available from: https://www.argonmedical.com/prod ucts/cleaner-rotational-throm bectomy-system. [Last accessed on 2020 May 12].
• 15 Turmel-Rodrigues L, Pengloan J, Rodrigue H, Brillet G, Lataste A, Pierre D, et al. Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int 2000;57:1124-40.
• 16 Irani FG, Teo TKB, Tay KH, Yin WH, Win HH, et al. Hemodialysis arteriovenous fistula and graft stenosis: Randomized trial comparing drug-eluting balloon angioplasty with conventional angioplasty. J Radiol 2018;289:238-47.
• 17 Park J, Kim J, Hwang S, Lee MK, Jang HR, Eun Lee J, et al. Arteriovenous graft patency outcomes and prognostic factors. Vascular 2019;27:128-34.
• 18 Kanterman RY, Vesely TM, Pilgram TK, Guy BW, Windus DW, Picus D. Dialysis access grafts: Anatomic location of venous stenosis and results of angioplasty. Radiology 1995;195:135-9.
• 19 Ayez N, Fioole B, Aarts RA, van den Dorpel MA, Akkersdijk GP, Dinkelman MK, et al. Secondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates. J Vasc Surg 2011;54:1095-9.
• 20 Shenoy S, Allon M, Beathard G, Brouwer-Maier D, Dember LM, Glickman M, et al. Clinical trial end points for hemodialysis vascular access: Background, rationale, and definitions. Clin J Am Soc Nephrol 2018;13:490-4.
• 21 Kim WS, Pyun WB, Kang BC. The primary patency of percutaneous transluminal angioplasty in hemodialysis patients with vascular access failure. Korean Circ J 2011;41:512-7.
• 22 Hsieh MY, Lai CL, Wu YW, Lin L, Ho MC, Wu CC. Impact on pulmonary arterial pressures after repeated endovascular thrombectomy of dialysis grafts: A prospective follow-up study. J Vasc Interv Radiol 2014;25:1883-9.