Application of percutaneous mechanical thrombectomy in autogenous fistulae

Articles proving that the majority of thrombosed autogenous fistulae can be recovered by interventional radiology are relatively recent, and the largest series to date have favored mechanical methods including manual catheter-directed aspiration, the Hydrolyzer, Amplatz Thrombectomy device, Arrow-Trerotola device, and the rotating pigtail. Rare contraindications to declotting include infection, fistula immaturity, and large aneurysms. The success rates range from 76% to 100% and compare well with the surgical approach whose effectiveness is not supported by comparable publications. The technical challenges of this outpatient procedure can include difficulties in initial catheterization of the vein or in crossing tight stenosis and actual removal of large thrombi. Although more challenging to declot than grafts, forearm autogenous fistulae are more rewarding. Better long-term patency has been achieved in the largest series to date as long as the underlying stenoses are sufficiently dilated (50% 1-year primary and 80% secondary patency rates). The results reported in the upper arm are less good. The unmasking of stenoses in close to 100% of cases warrants stenosis detection programs similar to those for grafts.