Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
J Vasc Access. 2023 Sep;24(5):965-971. doi: 10.1177/11297298211060964. Epub 2021 Nov 29.
This paper documents our experience and outcomes of using a relatively new endovascular rotational thrombectomy device for salvage of thrombosed vascular access.
A retrospective study reviewing patients with thrombosed native AVF or AVG who underwent endovascular declotting using a rotational thrombectomy device between November 2018 and May 2020 at a tertiary university hospital in Southeast Asia. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications.
A total of 40 patients underwent single session endovascular declotting of thrombosed vascular access. The mean follow-up period was 21.6 months (range 13.4-31 months). The technical success was 92.5% and clinical success was 80%. About 50% of patients had concomitant thrombolysis for pharmacomechanical thrombectomy. One patient had a myocardial infarction during the post-operative period. There were no other major complications within 30 days. The primary patency was 45.5% at 6 months and 22.7% at 12 months. Assisted primary patency was 68.1% at 6 months and 61.6% at 12 months, which was maintained up to 2 years. The secondary patency was 84.1% at 6 and 12 months.
Our study shows that rotational thrombectomy device for single session thrombectomy of thrombosed arteriovenous fistulas and grafts is safe and effective. A high technical and clinical success rate was achieved, with low complication rates and specific advantages compared to other techniques, including reduced length of hospital stay. Our reported mid-term outcomes are reasonable with an assisted primary patency of 62% at 12 and 24 months. The use of newer techniques and novel dedicated thrombectomy devices show promise.
本文记录了我们使用一种相对较新的血管内旋转血栓切除术设备治疗血栓形成的血管通路的经验和结果。
回顾性研究，纳入 2018 年 11 月至 2020 年 5 月期间在东南亚一家三级大学医院接受血管内溶栓治疗的血栓形成的自体动静脉瘘或移植物患者。我们评估了人口统计学、手术数据、技术和手术成功率、通畅率和并发症。
共有 40 例患者接受了单次血管内血栓切除术治疗血栓形成的血管通路。平均随访时间为 21.6 个月（范围 13.4-31 个月）。技术成功率为 92.5%，临床成功率为 80%。约 50%的患者同时接受了溶栓联合机械血栓切除术。1 例患者术后发生心肌梗死。术后 30 天内无其他重大并发症。6 个月和 12 个月时的原发性通畅率分别为 45.5%和 22.7%。辅助原发性通畅率分别为 6 个月时的 68.1%和 12 个月时的 61.6%，维持至 2 年。6 个月和 12 个月时的继发性通畅率分别为 84.1%。
我们的研究表明，旋转血栓切除术设备单次治疗血栓形成的动静脉瘘和移植物是安全有效的。实现了较高的技术和临床成功率，与其他技术相比，并发症发生率较低，具有特定的优势，包括住院时间缩短。我们报告的中期结果合理，辅助原发性通畅率为 12 个月和 24 个月时的 62%。新型技术和新型专用血栓切除术设备的使用显示出前景。
