Endovascular Declotting of Wall-Adherent Thrombi in Hemodialysis Vascular Access.

BACKGROUND To investigate the efficacy, safety, and patency following treatment of wall-adherent thrombus in hemodialysis vascular access with a wall-contact device, the Arrow-Trerotola percutaneous thrombolytic device (PTD). METHODS We retrospectively reviewed an existing database of procedures fulfilling the following criteria: thrombosed hemodialysis access, wall-adherent thrombus, and use of PTD for mechanical thrombectomy. Data on immediate success, complications, and patency were collected from medical records, dialysis records, and angiographic reports. RESULTS Ninety-three patients with 108 episodes of vascular access thrombosis were included in the study. Fifty-three of the procedures were performed on native fistulas, and 55 were on synthetic grafts. Anatomical and clinical success was achieved in 97% and 96% of the procedures, respectively. The average procedure time was 52 ± 23 minutes. Complications occurred in three of the procedures (2.7%), but none of these complications were device-related. The primary patency rates in the native fistula group were 57% and 42% at three and six months, respectively. The primary patency rates in the synthetic graft group were 40% at three months, and 27% at six months. The secondary patency rates at six months were 91% in the native fistula group, and 93% in the synthetic graft group. CONCLUSIONS Our results show that a wall-contact mechanical device, PTD, is effective and safe for endovascular removal of wall-adherent thrombi in hemodialysis vascular access in both native fistulas and synthetic grafts. KEY WORDS Adherent; Angioplasty; Endovascular; Hemodialysis; Thrombectomy; Vascular access.