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Novel approach to percutaneous thrombolysis in large caliber clotted vascular access using ultrasound-accelerated
Jessica A Zagory1, Paul E Perkowski, London C Guidry
11 Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA - USA.
Insights
Ultrasound-accelerated thrombolysis (USAT) effectively clears large clots in dialysis vascular access. This safe and efficient method preserves access for patients with end-stage renal disease, reducing complications and improving outcomes.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- End-stage renal disease (ESRD) incurs significant healthcare costs, with hemodialysis (HD) access complications contributing substantially.
- Vascular access thrombosis is a major issue in HD patients, leading to frequent interventions and high readmission rates.
- Current treatments for clotted vascular access face challenges in managing large clot burdens and preserving access patency.
Purpose of the Study:
- To evaluate the safety and efficacy of ultrasound-accelerated thrombolysis (USAT) for treating clotted large-caliber dialysis vascular access.
- To assess USAT's ability to resolve significant thrombus burden in conduits and central veins.
- To determine the effectiveness of USAT as a minimally invasive approach for restoring vascular access function.
Main Methods:
- A consecutive series of patients with thrombosed large-caliber dialysis vascular access were treated with catheter-directed thrombolysis using the EKOS EndoWave system.
- The study involved 12 patients undergoing 14 procedures for clotted hemodialysis access, including large conduits and central veins.
- Associated procedures like percutaneous transluminal angioplasty and stent placement were performed to address underlying causes of thrombosis.
Main Results:
- Complete thrombolysis was achieved in 7 out of 14 procedures.
- Four patients required additional percutaneous balloon thrombectomy for residual clot at the arterial anastomosis.
- Three patients needed rheolytic thrombectomy within the aneurysmal segment of their arteriovenous fistula (AVF).
Conclusions:
- Ultrasound-accelerated thrombolysis (USAT) is a safe and effective percutaneous technique for managing large clot burdens in dialysis vascular access.
- USAT offers a viable solution for preserving vascular access in ESRD patients experiencing significant thrombosis.
- The study highlights USAT's potential to reduce complications and improve patency rates for hemodialysis access.
Purpose:
End-stage renal disease has a high cost burden to the public. Surgical procedures such as hemodialysis (HD) access creation and transplant have high rates of vascular access complications, infections, and readmissions. Cost of HD care has increased to $19.4 billion in 2011; 30-day readmission rates are as high as 36%. There is a continuing need to preserve the route of vascular access for patients, given frequent thrombosis at a rate of 0.8 episodes per patient year at risk. We describe a novel method of thrombolysis using ultrasound-accelerated thrombolysis (USAT) technology for large caliber clotted vascular access.
Methods:
Consecutive patients with thrombosis of their dialysis vascular access that involved large caliber conduits or those that extended into large and/or central veins (axillary, subclavian, innominate) were chosen to undergo catheter-directed thrombolysis with the EKOS EndoWave system.
Results:
Twelve patients underwent a total of 14 procedures. Complete thrombolysis was achieved after seven procedures at the time of repeat fistulogram. Four patients required percutaneous balloon thombectomy to resolve remaining clot at the arterial anastomosis, and three required rheolytic thrombectomy in the aneurysmal segment of the arteriovenous fistula (AVF). All patients had an associated procedure (percutaneous transluminal angioplasty and/or stent placement) to treat the cause of thrombosis.
Conclusions:
USAT is a safe and effective percutaneous method of thrombolysis in patients who have large clot burden.
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