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Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: follow-up study
T Schmitz-Rode1, J E Wildberger, D Hübner
1Department of Diagnostic Radiology, University of Technology, Uinversitätsklinikum, Aachen, Germany. smiro@rad.rwth-aachen.de
Purpose:
To evaluate the feasibility, efficacy, and safety of mechanical thrombectomy of occluded dialysis access with use of a rotating mini-pigtail catheter.
Materials And Methods:
Thrombus was fragmented by mechanical action of the rotating pigtail tip (5-mm diameter), while the guide wire exited a sidehole at the pigtail curvature and served as a fixed rotation axis. Twenty-six procedures were performed in 22 patients (12 men, 10 women; mean age, 55.5 years). Native fistulas were treated in 15 instances, polytetrafluoroethylene (PTFE) grafts were treated in 11 instances. Average occlusion time was 20 hours +/- 13 (range, 5-46 hours), average occlusion length was 25.6 cm +/- 10.1 (range, 6-45 cm). Thrombus fragmentation was followed by balloon angioplasty of underlying stenoses.
Results:
In all 26 procedures, the dialysis access was successfully declotted with subsequent dialysis using the access (clinical success rate, 100%). Handling of the mini-pigtail catheter was simple and rapid, regardless of whether a graft or a native fistula was treated. Average duration of the intervention was 118 minutes +/- 30. Mean primary patency was 165 days +/- 167. Primary patency rate was 82% at 30 days, 65% at 3 months, and 47% at 6 months. There was no evidence of complications due to the thrombus fragmentation procedure.
Conclusion:
The results suggest that declotting of occluded dialysis grafts and fistulas with the mini-pigtail catheter is as effective and safe as other more established percutaneous therapies. It may serve as an easy-to-handle, low-budget alternative to current thrombectomy devices.
Insights
Mechanical thrombectomy using a rotating mini-pigtail catheter effectively declotted dialysis access in all procedures. This safe and simple method offers a low-budget alternative for treating occluded fistulas and grafts.
Area of Science:
- Vascular Surgery
- Interventional Nephrology
- Medical Devices
Background:
- Dialysis access occlusion is a common complication.
- Mechanical thrombectomy is a key treatment for restoring access patency.
Purpose of the Study:
- To assess the feasibility, efficacy, and safety of mechanical thrombectomy for occluded dialysis access using a novel rotating mini-pigtail catheter.
Main Methods:
- The rotating mini-pigtail catheter mechanically fragmented thrombus in 26 procedures (15 native fistulas, 11 PTFE grafts).
- Thrombus fragmentation was followed by balloon angioplasty for underlying stenoses.
- The guide wire acted as a fixed rotation axis for the catheter tip.
Main Results:
- 100% clinical success rate in declotting dialysis access, enabling immediate use.
- The mini-pigtail catheter was simple and rapid to handle in both native fistulas and PTFE grafts.
- No complications related to the thrombus fragmentation procedure were observed.
Conclusions:
- Mechanical thrombectomy with the mini-pigtail catheter is effective and safe for occluded dialysis access.
- This technique presents a cost-effective and user-friendly alternative to existing thrombectomy devices.