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Cho MS, Javed Z, Patel R, Karim MS, Chan MR, Astor BC, Gardezi AI. Impact of COVID-19 pandemic on hemodialysis access thrombosis. J Vasc Access 2024; 25:467-473. [PMID: 35953895 PMCID: PMC9379590 DOI: 10.1177/11297298221116236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Delay in care of suspected stenosis or thrombosis can increase the chance of losing a functioning hemodialysis access. Access to care and resources were restricted during the COVID-19 pandemic. To evaluate the impact of the pandemic on arteriovenous fistula (AVF) and arteriovenous graft (AVG) procedures we have assessed the number and success of thrombectomies done before and during the COVID-19 pandemic. METHODS We examined all AVF and AVG angiograms with and without interventions, including thrombectomies, performed at a single center during April 2017-March 2021 (pre-COVID-19 era) and April 2020-March 2021 (COVID-19 era). RESULTS The proportion of procedures that were thrombectomies was higher during the COVID-19 era compared to the pre-COVID-19 era (13.3% vs 8.7%, p = 0.009). The proportion of thrombectomy procedures was higher during COVID-19 for AVF (8.2% vs 3.0%, p < 0.001) but there was no difference for AVG (26.5% vs 27%, p = 0.99). There was a trend toward a higher likelihood of unsuccessful thrombectomy during COVID-19 (33.3% vs 20.4%, p = 0.08). CONCLUSIONS More dialysis access thromboses and unsuccessful thrombectomies were noted during the COVID-19 pandemic. This difference could be due to a delay in patients getting procedures to maintain their dialysis accesses.
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Affiliation(s)
- Min S Cho
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Zain Javed
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Ravi Patel
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Muhammad S Karim
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Micah R Chan
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Brad C Astor
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
- Department of Population Health
Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Ali I Gardezi
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
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Cavalcante RN, Nishinari K, Centofanti G, Krutman M, De Fina B, Sato VH, de Oliveira ES, Pereira LVB, Mohrbacher S, Bales AM, Ferreira BMC, Neves PDMDM, Chocair PR, Cuvello Neto AL. The role of vacuum-assisted mechanical thrombectomy in the management of acutely thrombosed arteriovenous fistulas and grafts. J Vasc Access 2024; 25:113-118. [PMID: 35633069 DOI: 10.1177/11297298221099469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the safety and efficacy of the mechanical thrombectomy with the Indigo System in the treatment of thrombosed arteriovenous fistulas and grafts. METHODS A retrospective search of endovascular procedures performed from November 2018 to June 2020 was conducted. Inclusion criteria were: acute arteriovenous fistula or graft thrombosis that underwent endovascular mechanical thrombectomy with Indigo System. The following information was collected from each case: sex, age, fistula modality, fistula location, treatment modality, and outcomes. Endpoints evaluated were: technical and clinical success rates; primary, assisted primary, and secondary patency rates; complication rates. RESULTS Twenty-six mechanical thrombectomy procedures for declotting of arteriovenous fistula thrombosis, using the Indigo System, were performed in 22 patients. Technical and clinical success was achieved in 23/26 cases (88%). Mean follow-up was 9 months (range 11-539 days). The 6-month primary, primary assisted, and secondary patency rates were 71%, 86%, 93% and the 12-month primary, primary assisted, and secondary patency rates were 71%, 72%, 80%, respectively. No technical or device-related complications were observed during thrombectomy, however two venous ruptures occurred on the angioplasty of the underlying stenosis. CONCLUSION In conclusion, vacuum-assisted thrombectomy of acutely thrombosed arteriovenous fistulas and grafts with Indigo System is safe and effective, providing good short term patency rates.
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Affiliation(s)
| | - Kenji Nishinari
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | - Guiherme Centofanti
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | - Mariana Krutman
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | - Bruna De Fina
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | | | | | | | - Sara Mohrbacher
- Hospital Alemão Oswaldo Cruz, Nephrology and Dialysis Center, São Paulo, Brazil
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3
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Maleux G. Management of Thrombosed Dialysis Access Circuits. Cardiovasc Intervent Radiol 2023; 46:1162-1167. [PMID: 37055545 DOI: 10.1007/s00270-023-03434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Abstract
Thrombotic occlusion of autologous arteriovenous fistulas or synthetic arteriovenous grafts is a serious adverse event in hemodialysis patients and declotting should be performed before next hemodialysis session, in order to avoid a central venous catheter. Various techniques exist to declot a thrombosed vascular access, including open surgical thrombectomy, catheter-directed thrombolysis and use of different types of percutaneous thrombo-aspiration catheters and mechanical thrombectomy devices. These devices can be categorized as devices with direct wall contact and hydrodynamic devices without direct wall contact. Technical and early clinical outcome results of percutaneous hemodialysis declotting are high and ranging between 70 and 100%; late clinical patency results are much lower related to restenosis or re-thrombosis; these patency results are higher for autologous arteriovenous fistulas compared to synthetic arteriovenous grafts and mainly depend on the combined efficacy of successful thrombectomy and durable treatment of the underlying stenoses, associated with the acute thrombosis.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
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4
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Franchin M, Tadiello M, Guzzetti L, Gattuso A, Mauri F, Cervarolo MC, D'Oria MGG, Tozzi M. Acute problems of hemodialysis access: Thrombosis, aneurysms, symptomatic high-flow fistulas, and complications related to central lines. Semin Vasc Surg 2023; 36:300-306. [PMID: 37330242 DOI: 10.1053/j.semvascsurg.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Hemodynamic complications frequently affect vascular access and are important causes of morbidity and mortality. We present a review of acute complications affecting vascular accesses, focusing on classical and new treatments. Acute complications in hemodialysis vascular access are often underestimated and undertreated, and can present a challenge for both vascular surgeons and anesthesiologists. Accordingly, we considered different anesthesiologic approaches to both hemorrhagic and nonhemorrhagic patients. A strict collaboration among nephrologists, surgeons, and anesthesiologists can potentially improve prevention and management of acute complications and quality of life.
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Affiliation(s)
- Marco Franchin
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy.
| | - Marco Tadiello
- Vascular Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luca Guzzetti
- Anaesthesiology Unit, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Varese, Italy
| | - Andrea Gattuso
- Vascular Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Francesca Mauri
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
| | - Maria Cristina Cervarolo
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
| | | | - Matteo Tozzi
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
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5
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Hicks A, Grzeda A, Schucht J, Bond J, Bush C, Dwivedi A, Sigdel A. Comparing Patency Rates of Arteriovenous Dialysis Access following Percutaneous Thrombectomy Using Various Catheter Directed Therapies. Ann Vasc Surg 2023; 92:131-141. [PMID: 36623720 DOI: 10.1016/j.avsg.2022.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 12/03/2022] [Accepted: 12/03/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Arteriovenous fistulas often require frequent interventions to maintain patency for hemodialysis. Interventions may include open or percutaneous thrombectomy with additional targeted interventions as indicated. We evaluated the primary and cumulative functional patency rates following three unique approaches to percutaneous thrombectomy of thrombosed dialysis access. METHODS A retrospective review of 236 unique patients who presented with thrombosed hemodialysis access was analyzed over a period of 4 years from 2016 to 2020. We analyzed a total of 413 procedures that utilized 3 separate percutaneous thrombectomy devices to assist with restoring patency. The Indigo System CAT-D Aspiration Thrombectomy Catheter (Penumbra; Alameda, CA), the Arrow-Trerotola Rotational Thrombectomy System (Teleflex; Wayne, PA) and the Angiojet Rheolytic Thrombectomy Catheter (Boston Scientific, Marlborough, MA) devices were compared for primary and cumulative functional patency. Primary patency was defined as time from percutaneous thrombectomy to next intervention (Angioplasty, stenting, and repeat thrombectomy). Cumulative functional patency was defined as time from percutaneous thrombectomy to time of access abandonment. Medical record chart review was utilized to determine patency rates. RESULTS A total of 413 percutaneous thrombectomy procedures were performed. Of the procedures performed, 98 utilized Angiojet, 103 utilized Trerotola, and 212 used Penumbra. The mean primary patency rates in (days) for the devices were as follows: Angiojet (194), Trerotola (204), and Penumbra (107). The mean cumulative functional patency rates (in days) for the devices were as follows: rheolytic thrombectomy (450 days), aspiration thrombectomy (292 days), and rotational thrombectomy (475 days). Angiojet versus Penumbra and Trerotola versus Penumbra both showed diminished patency rates when using the Penumbra catheter that were statistically significant (P < 0.05). CONCLUSIONS All percutaneous thrombectomy approaches do not result in the same primary or cumulative functional patency rates. Approaches with Trerotola and Angiojet resulted in improved primary and cumulative functional patency rates compared to those using Penumbra.
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Affiliation(s)
- Adam Hicks
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY.
| | - Anthony Grzeda
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Jessica Schucht
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Jordan Bond
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Charles Bush
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Amit Dwivedi
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Abindra Sigdel
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
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6
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Maßmann A, Hammer I, Ketteler M, Latus J. [Acute interventions-dialysis shunt recanalization]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:18-23. [PMID: 36443567 DOI: 10.1007/s00117-022-01089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND An arteriovenous fistula is vital for patients who need regular hemodialysis. Continuous patency and sufficient functionality determine quality of life and associated morbidity and mortality of patients. PROBLEM Following successful hemodialysis shunt creation, intimal hyperplasia and consecutive thrombosis or complete occlusion may cause different types of shunt dysfunctionality or even critical failure. OBJECTIVE Immediate shunt recanalization and revision by using an endovascular-first approach is crucial for long-term survival of hemodialysis fistula. There are several mechanisms available for catheter-based thrombus removal to unmask the typically underlying shunt stenosis. METHODS Primary technical recanalization success rates are very similar for clot cleaning. Treatment of intimal hyperplasia is preferably addressed by using drug-coated balloon angioplasty to allow for increased shunt patency compared to plain old balloon angioplasty. Stents and stent grafts are only used for resistant or repeated short-term recurrence of severe stenosis. Finally, surgical revision has a classical role in case of repeated failure of endovascular measures.
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Affiliation(s)
- Alexander Maßmann
- Diagnostische & Interventionelle Radiologie und Nuklearmedizin, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
| | - Inga Hammer
- Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
| | - Markus Ketteler
- Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
- Altersmedizin und Rehabilitation, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
| | - Jörg Latus
- Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
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7
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Ruan L, Yang Y, Ren G, Li W, Sun L, Zhang L. Scoop thrombectomy: A declotting technique for the treatment of thrombosed autologous arteriovenous fistula. A single-center retrospective study. PLoS One 2022; 17:e0276067. [PMID: 36227897 PMCID: PMC9562147 DOI: 10.1371/journal.pone.0276067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Thrombosis is one of the main complications leading to the failure of autologous arteriovenous fistula (AVF) for patients with renal failure. Thrombectomy is one of the major therapies to remove thrombi to salvage the AVF and prolong its patency. MATERIALS AND METHODS Fifty-six patients with AVF thrombosis at the anastomosis were recruited for this study and underwent thrombectomy procedures. Their clinical variables were collected. The vasculature was accessed at the site of the aneurysmal dilatation. Under ultrasound guidance, a scoop thrombectomy procedure was performed by anterograde and retrograde scooping to remove the thrombus using forceps. Then, a sheath was placed in the direct vertical direction. Angioplasty was performed with a balloon to treat the underlying primary arteriovenous stenosis. Patients were followed up for 12 months after surgery. The procedural success, primary and secondary patency rates, and incidence of procedure-related complications were analyzed. RESULTS There were 2 minor (3.6%) and no major complications. Clinical success was achieved in 55 of the 56 procedures (98.2%). No symptomatic pulmonary embolism or arterial embolization was noted. The primary patency rates at 3, 6, and 12 months were 92.9, 83.8, and 73.3%%, respectively, according to the Kaplan-Meier survival analysis. CONCLUSION Scoop thrombectomy is a safe procedure with high technical success and a low complication rate, and it is an effective method for patients to receive hemodialysis immediately.
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Affiliation(s)
- Lin Ruan
- Nephrology Department, Hebei Medical University First Hospital, Shijiazhuang, Hebei, China
| | - Yanli Yang
- Nephrology Department, Hebei Medical University First Hospital, Shijiazhuang, Hebei, China
| | - Guangwei Ren
- Nephrology Department, Hebei Medical University First Hospital, Shijiazhuang, Hebei, China
| | - Wen Li
- Nephrology Department, Hebei Medical University First Hospital, Shijiazhuang, Hebei, China
| | - Lijun Sun
- Nephrology Department, Hebei Medical University First Hospital, Shijiazhuang, Hebei, China
| | - Lihong Zhang
- Nephrology Department, Hebei Medical University First Hospital, Shijiazhuang, Hebei, China
- * E-mail:
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8
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Manov JJ, Mohan PP, Vazquez-Padron R. Arteriovenous fistulas for hemodialysis: Brief review and current problems. J Vasc Access 2021; 23:839-846. [PMID: 33818180 DOI: 10.1177/11297298211007720] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The number of people worldwide living with end-stage renal disease is increasing. Arteriovenous fistulas are the preferred method of vascular access in patients who will require hemodialysis. As the number of patients with arteriovenous fistulas grows, the role of physicians who intervene who maintain and salvage these fistulas will grow in importance. This review aims to familiarize practitioners with the rationale for arteriovenous fistula creation, the detection of fistula dysfunction, and the state of the art on fistula maintenance and preservation. Current controversies are briefly reviewed.
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Affiliation(s)
- John J Manov
- Department of Radiology, University of Miami, Miami, FL, USA
| | - Prasoon P Mohan
- Department of Interventional Radiology, University of Miami, Miami, FL, USA
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9
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Vrtovsnik F, Brunet P, Chauveau P, Juillard L, Lasseur C, Mercadal L. [Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults]. Nephrol Ther 2020; 16:376-386. [PMID: 33139227 DOI: 10.1016/j.nephro.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 11/16/2022]
Affiliation(s)
- François Vrtovsnik
- Service de néphrologie, Nord-université de Paris, Inserm U1149, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Philippe Brunet
- Service de néphrologie, centre de néphrologie et transplantation rénale, université Aix-Marseille, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Philippe Chauveau
- Aurad-Aquitaine, 2, allée des Demoiselles, 33171 Gradignan cedex, France
| | - Laurent Juillard
- Service de néphrologie, Inserm U1060, université de Lyon, hôpital Herriot, place d'Arsonval, Lyon cedex 03, France
| | - Catherine Lasseur
- Aurad-Aquitaine, 2, allée des Demoiselles, 33171 Gradignan cedex, France
| | - Lucile Mercadal
- Département uro-néphrologie transplantation rénale, Sorbonne université, Inserm U1018, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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10
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Bundled Medicare Payments: Trends in Utilization and Physician Payments for Dialysis Arteriovenous Fistula and Graft Maintenance Procedures From 2010 to 2018. AJR Am J Roentgenol 2020; 215:785-789. [DOI: 10.2214/ajr.19.22675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice. J Interv Cardiol 2020; 2020:4191079. [PMID: 32904502 PMCID: PMC7456496 DOI: 10.1155/2020/4191079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/15/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients' clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p < 0.0001), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p = 0.049), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p = 0.0051), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p = 0.0015), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p < 0.0001) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p < 0.0001). No major periprocedural bleeding was detected. Conclusions CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation.
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12
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Arinze N, Ryan T, Pillai R, Vilvendhan R, Farber A, Jones DW, Rybin D, Levin SR, Cheng TW, Siracuse JJ. Perioperative and long-term outcomes after percutaneous thrombectomy of arteriovenous dialysis access grafts. J Vasc Surg 2020; 72:2107-2112. [PMID: 32289439 DOI: 10.1016/j.jvs.2020.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Maintenance of functional arteriovenous grafts (AVGs) for dialysis is difficult secondary to low primary patency, need for reinterventions, and limited alternative dialysis access options. We assessed our experience with percutaneous thrombectomy for treatment of occluded AVGs. METHODS We performed a retrospective analysis of all percutaneous thrombectomies for AVGs from 2015 to 2017. These were generally performed using mechanical thrombectomy and occasional chemical tissue plasminogen activator thrombolysis, over-the-wire balloon embolectomy for inflow, and adjunctive inflow and outflow interventions as necessary. Perioperative outcomes, long-term patency, reinterventions, and need for new permanent access placement were analyzed. RESULTS There were 218 percutaneous thrombectomies performed on 86 AVGs in 77 patients. Approximately half (53.2%) of the patients were male and 68.8% were black. Mean age was 61.1 ± 13.0 years. At the time of thrombectomy, 73.8% underwent venous outflow interventions and 4.5% underwent arterial inflow interventions. Within 30 days, 24.8% of declotted grafts underwent repeated percutaneous thrombectomy, 14.3% required tunneled dialysis catheter placement, 4% developed minor access site or graft infections, and one patient underwent surgical arterial thrombectomy for arm ischemia. There were no venous thromboembolic, cardiopulmonary, or cerebrovascular complications or clinically significant pulmonary embolism. At 1 year and 3 years after percutaneous thrombectomy, freedom from repeated thrombosis was 37% and 18%, respectively, and freedom from new dialysis access placement was 66% and 51%, respectively. Overall patient survival was 82% at 3 years. CONCLUSIONS Percutaneous thrombectomy of AVGs is safe and is associated with acceptable patency rates. This minimally invasive method extends AVG use for these high-risk patients with limited dialysis access options.
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Affiliation(s)
- Nkiruka Arinze
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Tyler Ryan
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Rohit Pillai
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Rajendran Vilvendhan
- Division of Interventional Radiology, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Denis Rybin
- Department of Biostatistics, Boston University, School of Public Health, Boston, Mass
| | - Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass.
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13
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Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: A preliminary experience. J Vasc Surg Venous Lymphat Disord 2020; 8:174-181. [DOI: 10.1016/j.jvsv.2019.10.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
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14
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Piacentino F, Coppola A, Zaghetto A, Macchi E, De Marchi G, Ossola C, Zorzetto G, Beneventi A, Casamassima N, Tagliaferri C, Tozzi M, Piffaretti G, Fontana F, Genovese EA. Vacuum-assisted mechanical thrombectomy in extensively occlusive thrombosis of dialysis arteriovenous grafts with indigo system. J Vasc Access 2020; 21:673-679. [PMID: 31928304 DOI: 10.1177/1129729819899264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To present a selected series of extensively occlusive thrombosis of arteriovenous graft treated with the Penumbra's Indigo System. MATERIALS AND METHODS Ten patients with acute (within 72 h) extensively occlusive thrombosis of arteriovenous graft (mean extension = 30.1 (range = 15-45) cm) were treated at our institution with the Indigo System. Of the 10 cases, thrombosis was extended to venous outflow in 7 cases and to both arterial inflow and venous outflow in 3 cases. RESULTS Both anatomic and clinical success were achieved in 8 of the 10 procedures (80.0%). In the 2 cases of technical failure, the patients underwent surgical thrombectomy with the finding of arteriovenous graft exhaustion, which was then replaced. The 6-month primary patency, primary-assisted patency, and secondary patency rates were 37.5% (3/8), 50.0% (4/8), and 62.5% (5/8). We reported 2 complications (one minor and one major adverse event). CONCLUSION Percutaneous mechanical thrombectomy aspiration with Indigo System is a relatively safe and effective procedure and can be used even in extensively thrombosed arteriovenous graft.
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Affiliation(s)
- Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Coppola
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Zaghetto
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Edoardo Macchi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giuseppe De Marchi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Christian Ossola
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giada Zorzetto
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Alessandro Beneventi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Nicola Casamassima
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Chiara Tagliaferri
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Matteo Tozzi
- Department of Vascular Surgery, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gabriele Piffaretti
- Department of Vascular Surgery, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Eugenio Annibale Genovese
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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15
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Lopez R, Yamashita TS, Neisen M, Fleming M, Colglazier J, Oderich G, DeMartino R. Single-center experience with Indigo aspiration thrombectomy for acute lower limb ischemia. J Vasc Surg 2020; 72:226-232. [PMID: 31918998 DOI: 10.1016/j.jvs.2019.10.079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/01/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acute lower limb ischemia (ALLI) is a challenging vascular emergency with notable morbidity. Aspiration mechanical thrombectomy (AMT) devices are an alternative approach to remove thrombus in the peripheral arterial system and to restore limb perfusion, but data are limited. We evaluated the outcomes of AMT for the treatment of ALLI at our institution. METHODS We performed a single-center retrospective review of patients with ALLI treated with Indigo (Penumbra Inc, Alameda, Calif) AMT device from 2014 to 2017. The primary outcome was technical success (restoration of blood flow with <50% residual thrombus without need for catheter-directed thrombolysis [CDT] or open surgery) as main treatment or adjunctive treatment (after failure of another modality). Indications, anatomic segments treated, outcomes, and complications were reviewed. RESULTS There were 41 patients (68% male, 32% female; mean age, 67 years; range, 27-90 years) who underwent 43 procedures. The cause of ALLI was embolism (18), native vessel thrombosis (13), bypass thrombosis (7), intraluminal thrombus due to pseudoaneurysm (1), stent thrombosis (1), intraprocedural embolization (1), recurrent thrombosis of native vessel (1), and chronic thrombosis (1). AMT was the main treatment in 29 cases and adjunctive in 14. Technical success was 52% (15/29) as main treatment and 50% (7/14) as adjunctive treatment. Thrombolysis was avoided in 53% of patients (23/43). There were six thrombotic recurrences, one after successful isolated AMT. The other five required multiple modalities after AMT failure. There were no 30-day deaths. Five patients required amputations, but only one after successful AMT. Complications included intraoperative distal embolization (two), access site hematoma (one), pseudoaneurysm (one), acute kidney injury (one), and spontaneous calf hematoma (one). There were no blood transfusions required or severe bleeding complications. CONCLUSIONS With an overall success rate of 51% in selected patients, the Indigo AMT device avoided the need for CDT or open surgery in about half of patients with ALLI. The device has a favorable safety profile, particularly in high-risk cases. Given its moderate effectiveness, the role of Indigo AMT in the management of ALLI will further be defined by the description of optimal technique, the determination of treatment indications, and a direct comparison with CDT.
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Affiliation(s)
- Ricardo Lopez
- Department of Radiology, Mayo Clinic, Rochester, Minn
| | | | - Melissa Neisen
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minn
| | - Mark Fleming
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jill Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
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16
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Teter K, Arko F, Muck P, Lamparello PJ, Khaja MS, Huasen B, Sadek M, Maldonado TS. Aspiration thrombectomy for the management of acute deep venous thrombosis in the setting of venous thoracic outlet syndrome. Vascular 2019; 28:183-188. [PMID: 31888420 DOI: 10.1177/1708538119895833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Venous thoracic outlet syndrome, known by the eponym Paget–Schroetter syndrome, is seen in healthy, young individuals with “effort-induced thrombosis.” Endovascular therapies, including catheter-directed thrombolysis, have been described in the acute management of the upper extremity deep venous thrombosis; however, we assessed the technical success of treating this entity using a mechanical aspiration thrombectomy system. Methods This was a multi-center retrospective review of patients with venous thoracic outlet syndrome with acute thrombosis treated with the Indigo continuous aspiration mechanical thrombectomy system. Charts from patients with venous thoracic outlet syndrome and acute deep venous thrombosis treated with this system at our institution along with three data sharing locations were reviewed for demographics, deep venous thrombosis risk factors, imaging modalities used for diagnosis, extent of axillosubclavian deep venous thrombosis, treatment details, adjunctive therapies, and complications. The primary outcome was technical success (resolution of >70% of thrombus). Results There were 16 patients (50% male) with a mean age of 33 years (range 17–69 years). Six patients had underlying venous thromboembolism risk factors including use of contraceptives ( n = 2), prior deep venous thrombosis ( n = 3), and known thrombophilia ( n = 1). Fifteen patients had complete venous occlusion, and the extent of venous involvement included subclavian ( n = 14), axillary ( n = 16), and brachial ( n = 7). The majority (81.25%) of patients were treated in a single setting, and technical success was achieved in all cases with the use of adjunctive therapies. Only three patients required additional overnight thrombolytic therapy. Conclusions The Penumbra Indigo system, often in combination with adjunctive catheter-directed thrombolysis and venoplasty, is a safe and effective device for the treatment of acute upper extremity deep venous thrombosis in the setting of Paget–Schroetter syndrome. No patients experienced central embolization or post-operative renal insufficiency. One-third of patients avoided any additional catheter-directed thrombolysis exposure, and technical success was achieved in all cases. A single bleeding complication was observed in a patient undergoing overnight adjunctive catheter-directed thrombolysis. All patients maintained patency until time of first rib resection.
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Affiliation(s)
- Katherine Teter
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Frank Arko
- Sanger Heart and Vascular Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | | | | | - Minhaj S Khaja
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Bella Huasen
- Lancashire University Teaching Hospital, Manchester, UK
| | - Mikel Sadek
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Thomas S Maldonado
- Department of Surgery, New York University Langone Health, New York, NY, USA
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17
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Wakabayashi M. Ultrasound-guided removal of organized thrombi using biopsy forceps in dialysis patients with arterio-venous access occlusion. J Vasc Access 2019; 21:475-480. [PMID: 31782681 DOI: 10.1177/1129729819888431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION As a countermeasure against the organized thrombi frequently observed in vascular access occlusion, we devised a percutaneous excision method for organized thrombi under superficial ultrasound guidance using biopsy forceps. The Radial JawTM 3 (2 mm) biopsy forceps of Boston Scientific Corporation was used. The usefulness of this method was investigated. METHOD The following protocol, which is suitable for endovascular treatment, was prepared and used: (1) all procedures were performed under ultrasound guidance and (2) use of the forceps was assisted via a long sheath in cases involving a complicated bloodstream. SUBJECTS Among 564 cases of arterio-venous access occlusion that received treatment at this hospital between May 2014 and April 2017, the subjects of this study were 468 cases who could be followed up. Thrombectomy of an organized thrombus using the biopsy forceps was performed 194 times in 138 cases. Biopsy forceps were used in the initial treatment in a total of 115 cases, including 71 cases of acute occlusion of an autologous vein, 3 cases of chronic occlusion of an autologous vein, and 41 cases of acute occlusion of a prosthetic vessel. RESULTS The initial success rate for all cases of occlusion was 97.2%. The initial success rate for cases in which biopsy forceps were used was 98.2%. For cases using biopsy forceps, the primary patency rates were 47.1% at 3 months, and the secondary patency rates (until occlusion) were 89.1% at 3 months. CONCLUSION This method was considered to be a valuable choice as a countermeasure against organized thrombi.
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18
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Hall D, Shaughnessy D, Drawz P, Akkina S, Esten A, Foley RN, Reule S. Time to thrombectomy is associated with increased risk for dialysis catheter placement. J Ren Care 2019; 45:232-238. [PMID: 31448871 DOI: 10.1111/jorc.12295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arteriovenous dialysis access, fistulae (AVF) or grafts (AVG), are associated with significant rates of thrombosis. Timely thrombectomy may have a significant impact on immediate and long-term access survival. However, switching to a catheter is associated with higher rates of morbidity and mortality compared with those who have an AVF or AVG. OBJECTIVES The goal of this study was to evaluate whether time to thrombectomy increases the risk for loss of dialysis access and subsequent placement of a dialysis catheter at hospital discharge, at 6 months, 12 months, and data at any time after discharge. METHODS Using retrospective data, 444 patients were identified as having undergone thrombectomy for dialysis access dysfunction between January 2008 and April 2015, with 122 hospital admissions primarily for thrombectomy. RESULTS The mean age was 60.4 years, 65% were male, and 44.3% had an arteriovenous fistula as their dialysis access. The mean time to thrombectomy was 10.8 hours, and 14 patients utilised a catheter for haemodialysis as primary access upon discharge. After adjustment for prior access intervention, access type, and time to thrombectomy, the adjusted odds ratios (AOR) of a one-day delay in thrombectomy was associated with a twofold increase in requirement for catheter at discharge and at 6 months. This association remained present at any time after discharge. CONCLUSION In this study of patients cared for within an academic health system, a single day delay in thrombectomy nearly doubled the risk of needing a dialysis catheter at hospital discharge, 6 months, or any time after discharge.
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Affiliation(s)
- Damian Hall
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Shaughnessy
- University of Minnesota School of Public Health (SPH), University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul Drawz
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sunil Akkina
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Esten
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert N Foley
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Scott Reule
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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19
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Gallieni M, Hollenbeck M, Inston N, Kumwenda M, Powell S, Tordoir J, Al Shakarchi J, Berger P, Bolignano D, Cassidy D, Chan TY, Dhondt A, Drechsler C, Ecder T, Finocchiaro P, Haller M, Hanko J, Heye S, Ibeas J, Jemcov T, Kershaw S, Khawaja A, Labriola L, Lomonte C, Malovrh M, Marti I Monros A, Matthew S, McGrogan D, Meyer T, Mikros S, Nistor I, Planken N, Roca-Tey R, Ross R, Troxler M, van der Veer S, Vanholder R, Vermassen F, Welander G, Wilmink T, Koobasi M, Fox J, Van Biesen W, Nagler E. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34:ii1-ii42. [PMID: 31192372 DOI: 10.1093/ndt/gfz072] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | | | | | - Jan Tordoir
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Davide Bolignano
- Institute of Clinical Physiology of the Italian National Council of Research, Reggio Calabria, Italy.,ERBP, guideline development body of ERA-EDTA, London, UK
| | | | | | | | - Christiane Drechsler
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Würzburg, Würzburg, Germany
| | - Tevfik Ecder
- Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | | | - Maria Haller
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | - Sam Heye
- Jessa Hospital, Hasselt, Belgium
| | - Jose Ibeas
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Aurangzaib Khawaja
- Queen Elisabeth Hospital, University Hospitals Birmingham, West Midlands Deanery, Birmingham, UK
| | | | - Carlo Lomonte
- Miulli General Hospital, Acquaviva delle Fonti, Italy
| | | | | | | | | | | | | | - Ionut Nistor
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Medicine and Pharmacy, Iasi, Romania
| | - Nils Planken
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ramon Roca-Tey
- Hospital de Mollet, Fundació Sanitària Mollet, Barcelona, Spain
| | - Rose Ross
- Ninewells Hospital Scotland, Dundee, UK
| | | | | | | | | | | | - Teun Wilmink
- Heart of England NHS foundation Trust, Birmingham, UK
| | - Muguet Koobasi
- ERBP, guideline development body of ERA-EDTA, London, UK
| | - Jonathan Fox
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Glasgow, UK
| | - Wim Van Biesen
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
| | - Evi Nagler
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
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20
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Lopez R, DeMartino R, Fleming M, Bjarnason H, Neisen M. Aspiration thrombectomy for acute iliofemoral or central deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2019; 7:162-168. [PMID: 30639411 DOI: 10.1016/j.jvsv.2018.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The use of catheter-directed thrombolysis (CDT) may provide clinical benefit in patients with acute deep venous thrombosis (DVT), but significant doubt remains about its indications and risks. We assessed technical success in resolution of acute iliofemoral or central DVT after single-session treatment with a novel mechanical aspiration thrombectomy device as an alternative to initiation of CDT. METHODS This was a single-center retrospective review of patients with acute iliofemoral or central DVT treated with the Indigo continuous aspiration mechanical thrombectomy 8 system (Penumbra, Inc, Alameda, Calif) from 2016 to 2017. The primary outcome was technical success, defined as resolution of >70% of thrombus without need for postaspiration CDT, as an initial or adjunctive treatment. Secondary end points included DVT recurrence and treatment complications. RESULTS There were 10 patients (50% male) with a median age of 44 years (range, 19-68 years). Indication for treatment was DVT (n = 4), recurrent DVT (n = 1), stent thrombosis (n = 3), high-grade extrinsic narrowing of the inferior vena cava (IVC) due to immunoglobulin G4-related disease (n = 1), and IVC obstruction from liver tumor invasion (n = 1). Five patients had underlying May-Thurner syndrome. Five patients had iliofemoral involvement, two iliocaval, and one iliac vein alone. Two patients had central DVT, one of them involving the IVC and one involving the superior vena cava with brachiocephalic extension. Aspiration thrombectomy was technically successful in a total of six patients. Success was achieved in five of eight patients as the initial or main treatment modality and as an adjunctive treatment in one of two patients. Of the four patients in whom aspiration thrombectomy was not successful, three underwent successful further treatment with CDT. Recurrence after successful aspiration was seen in two patients. One patient developed pulmonary embolism that required no additional treatment. One patient experienced severe headaches treated with oral analgesics. CONCLUSIONS We observed a technical success of 60% for acute iliofemoral and central DVT with an aspiration thrombectomy system that allowed definitive treatment in one setting. As a novel therapy, this avoided the need for thrombolysis in the majority of selected cases with no bleeding complications and is a promising technique for acute DVT management.
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Affiliation(s)
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Mark Fleming
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Melissa Neisen
- Division of Interventional Radiology, Mayo Clinic, Rochester, Minn
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21
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Sistema de Aspiración INDIGO® de Penumbra. ANGIOLOGIA 2019. [DOI: 10.20960/angiologia.00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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