Dialysis grafts arterial plug: retrieval using the tulip sheath device in vitro

Complications Related to Percutaneous Thrombectomy of Hemodialysis Grafts

Purpose

To retrospectively review the complications reported during percutaneous thrombectomy procedures performed on polytetrafluoroethylene hemodialysis grafts.

Materials and Methods

A retrospective review revealed that 935 percutaneous thrombectomy procedures were performed at our institution between January 1993 and June 2001. The type and number of procedures include: Arrow PTD (527), pulse-spray with urokinase (240), Amplatz Thrombectomy Device (96), AngioJet (17), Oasis (15), Hydrolyser (10), Endovac (7), Lyse and Wait (7), Thrombex (6), Cragg brush (6), Castaneda brush (4). Complications were reported to have occurred in 31 patients. The radiology reports and medical records of these patients were reviewed.

Results

The overall complication rate was 3.3%. The type and number of complications included: rupture of a vein during angioplasty (13), severe cardiopulmonary distress (4), arterial emboli (4), rigors related to urokinase (3), minor bleeding (2), hypoxia with chest pain (2), other assorted complications (3). There was one death resulting from a fall from the angiography table immediately following the procedure. There were 12 minor complications, requiring minimal treatment, and 19 major complications that altered the course of the procedure or treatment of the patient.

Conclusion

The most common complication was angioplasty-induced rupture of the vein or graft. The most severe complications occurred immediately following dislodgement of the arterial plug and were likely due to acute pulmonary embolization.

Hemodialysis access thrombosis

For the over 400,000 patients in the United States dependent on hemodialysis, arteriovenous (AV) access thrombosis may lead to missed dialysis sessions, inpatient admissions and the need for placement of temporary dialysis catheters. It is also the leading cause of permanent access loss. Percutaneous declotting is generally preferred over surgical thrombectomy. Various percutaneous approaches can be employed including the lyse-and-wait technique, thromboaspiration, pulse spray aided pharmacomechanical thrombolysis, and use of mechanical thrombectomy device.

Minimal Modification to the Trerotola Backbleeding Technique Increases Its Effectiveness

Thrombectomy of a clotted upper arm access may be complicated by brachial artery embolization. A number of techniques have been described to relieve the embolization that may not always be successful. Backbleeding is one such technique. We describe a minimal modification that makes backbleeding more effective.

Mechanical thrombectomy devices to treat thrombosed hemodialysis grafts

Treatment of a thrombosed hemodialysis graft is an ideal application for a mechanical thrombectomy device. The soft, acute thrombus contained within the graft can be quickly macerated and removed with minimal risk of damaging native vascular endothelium. There are no universally accepted techniques for using mechanical thrombectomy devices to treat a thrombosed vascular access. To the contrary, there are a variety of thrombectomy methods that are currently utilized by interventional radiologists. Each device has its own niche and is best utilized for certain specific situations. A busy interventionalist should be familiar with several of these thrombectomy devices to most effectively treat the variety of clinical problems that may be encountered.