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Hydrodynamic thrombectomy of hemodialysis fistulas: first clinical results
D Vorwerk1, M Sohn, K Schurmann
1Department of Diagnostic Radiology, Technical University of Aachen, Germany.
Purpose:
A hydrodynamic thrombectomy system was used for the treatment of recent dialysis shunt thrombosis.
Patients And Methods:
Sixteen shunt thromboses in 14 patients were included in the study. There were seven polytetrafluoroethylene grafts and nine native arteriovenous fistulas. Occlusion time ranged from 6 to 48 hours, and thrombus length ranged from 4 to 40 cm.
Results:
Thrombectomy was technically successful in 15 of 16 instances. No significant residual thrombus was found in 15 cases. In one case, half of the thrombus remained in the vessel and the procedure failed technically. One embolus to the radial artery occurred after balloon dilation following hydrodynamic thrombectomy and was removed percutaneously. Early rethrombosis within 24 hours occurred in five shunts; four more rethrombosed within 2 weeks to 3 months. Eleven shunts were available for follow-up. Cumulative patency was 41% after 6 months.
Conclusion:
Hydrodynamic thrombectomy is a promising concept for declotting of both hemodialysis grafts and native shunts and may offer an alternative to thrombolysis and surgical thrombectomy.