Sharafuddin M J, Titus J L, Gu X, Hunter D W, Amplatz K
Department of Radiology, University of Minnesota Hospital and Clinic, 420 Delaware St., S.E., Minneapolis, MN 55455, USA.
Cardiovasc Intervent Radiol. 1997 Mar-Apr;20(2):154-8. doi: 10.1007/s002709900126.
The "arterial plug" is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts following thrombolytic therapy. We studied the physical and morphological characteristics of the plug and determined the feasibility of transcatheter removal in vitro using the tulip compression thrombectomy system. Sixteen thrombus plugs were recovered during surgical thrombectomy of clotted human dialysis grafts. The physical and gross physical characteristics of all plugs were analyzed. Eight specimens were evaluated microscopically. Transcatheter compression thrombectomy of eight plugs was attempted in vitro. Each plug was embedded in a polyvinyl tube filled with newly clotted blood and connected to a flow circuit. First, balloon-assisted aspiration thrombectomy (BAT) of soft thrombus was performed, while sparing the distal-most segment containing the plug. The tulip sheath was then introduced facing the "arterial end" of the tube. The thrombus segment containing the plug was pulled back into the tulip mesh using either a 3 Fr Fogarty balloon catheter or a self-expanding rake. The tulip was closed to compress and remove the trapped plug. Near-complete thrombectomy of soft clot was achieved in all tested tubes. Compression and retrieval of the entire arterial plug was successful in all except one, where only partial compression of the plug occurred, presumably due to fibrotic changes. No fragmentation or embolization occurred in the remaining procedures. Spongy consistency was noted in 94% of the specimens. Microscopic evaluation showed organized layered thrombus with compaction in five plugs. Transcatheter removal of a thrombus plug is feasible in vitro using the tulip compression-thrombectomy system.
“动脉栓子”是一种顽固的血栓，在溶栓治疗后，常持续存在于血液透析移植物动脉吻合处形成的血栓中。我们研究了栓子的物理和形态特征，并确定了使用郁金香压迫血栓切除术系统在体外经导管取出栓子的可行性。在对人类凝血透析移植物进行手术取栓过程中，回收了16个血栓栓子。分析了所有栓子的物理和大体物理特征。对8个标本进行了显微镜评估。在体外尝试对8个栓子进行经导管压迫血栓切除术。每个栓子嵌入一根充满新形成凝血的聚乙烯管中，并连接到一个血流回路。首先，对软血栓进行球囊辅助抽吸血栓切除术（BAT），同时保留包含栓子的最远端部分。然后将郁金香鞘管朝向管的“动脉端”插入。使用3F Fogarty球囊导管或自膨胀耙子将包含栓子的血栓段拉回到郁金香网中。关闭郁金香装置以压迫并取出被困的栓子。在所有测试管中，软血栓几乎完全被清除。除了一个栓子仅发生部分压迫（可能是由于纤维化改变）外，其余所有栓子的压迫和取出均成功。在其余操作中未发生碎片形成或栓塞。94%的标本呈现海绵状质地。显微镜评估显示，5个栓子中有组织化的分层血栓且有压实现象。使用郁金香压迫血栓切除术系统在体外经导管取出血栓栓子是可行的。
