Vorwerk D, Schurmann K, Müller-Leisse C, Adam G, Bücker A, Sohn M, Kierdorf H, Günther R W
Department of Diagnostic Radiology, Technical University of Aachen, Pauwelsstrasse, 52057 Aachen, Germany.
Nephrol Dial Transplant. 1996 Jun;11(6):1058-64.
To describe efficacy of hydrodynamic thrombectomy for occluded dialysis native and graft fistulae in 51 instances.
Fifty-one hydrodynamic thrombectomies of 34 native and graft a-v fistulae were performed. There were 32 thrombectomies in PTFE grafts and 19 procedures in native Brescia-Cimino fistulae. Multiple thrombectomies were performed in 11 of 34 fistulae. The estimated occlusion time was 36.4+/-22 h. The length of the occluded segment ranged from 2 to 50 cm (mean 28.8 cm). In all cases, a 7 F hydrodynamic thrombectomy catheter was used. Double-cannulation technique was used for graft fistulae, single-cannulation for native fistulae. Additionally, balloon dilatation was performed in all 51 cases, stenting in six, and aspiration thrombectomy in two cases.
Arterialized flow was re-established by hydrodynamic thrombectomy and PTA in 43 of 51 cases (84%). By additional use of other techniques, technical success improved to 46 of 51 procedures (90%). Early re-thrombosis occurred in six cases within 24 h of thrombectomy (11%). Clinical success was achieved in 39 of 46 technically successful cases (85%). Cumulative patency was calculated at 63% after 1 week, 57% after 1 month, 48% after 3 months, 37% after 6 months, and 32% after 12 months. Patency of native fistulae after thrombectomy was better than patency of grafts.
Hydrodynamic thrombectomy is an effective percutaneous technique for declotting haemodialysis fistulae and grafts recently thrombosed.
