Mechanical Thrombectomy in Acute Thrombosis of Dialysis Arteriovenous Fistulae and Grafts Using a Vacuum-Assisted Thrombectomy Catheter: A Multicenter Study.

ABSTRACT

PURPOSE: To prospectively analyze technical and clinical outcome of percutaneous thrombectomy aspiration using a vacuum-assisted thrombectomy catheter in acutely thrombosed dialysis arteriovenous fistula (AVF) and/or arteriovenous graft (AVG). MATERIALS AND METHODS: From June 2016 to April 2017, 35 patients (average age, 61.8 y; range, 33-81 y) presenting with acute thrombosis of dialysis AVF and/or AVG were prospectively evaluated for mechanical thrombectomy using the Indigo System. Adjunctive therapies and procedure-related complications were noted. Technical success, clinical success, primary patency, primary assisted patency, and secondary patency of the dialysis fistula were assessed. RESULTS: Mean follow-up time was 8.5 months (range, 3-12 months). Technical success was 97.1% (34/35 patients). Clinical success was 91.4% (32/35 patients). Complications included hematoma (n = 1), thrombosis < 24 hours (n = 1), and perforation (n = 1). Other mechanical/aspiration thrombectomy devices were used in 1 site to clear the thrombus burden (Arrow-Trerotola [2.8%; 1/35 patients] and Fogarty [5.7%; 2/35 patients]). Average procedure time was 38.1 minutes (range, 15-140 min). Average blood loss during the procedure was 122.5 mL (range, 50-300 mL). The 6-month primary patency, primary assisted patency, and secondary patency were 71%, 80%, and 88.5%. No risk factors for early dialysis fistula occlusion were identified. There was no 30-day mortality. CONCLUSIONS: Percutaneous mechanical thrombectomy aspiration of thrombosed dialysis AVF and/or AVG with a vacuum-assisted thrombectomy catheter is a safe procedure with a low complication rate and effective method for restoring patency before hemodialysis.