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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

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
› Author Affiliations Financial support and sponsorship Nil.
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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


Publication History

Received: 27 May 2019
Received: 30 May 2019

Accepted: 08 June 2019

Article published online:
16 March 2021

© 2019. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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