PERCUTANEOUS BALLOON-ASSISTED ASPIRATION THROMBECTOMY OF CLOTTED HEMODIALYSIS ACCESS GRAFTS

PURPOSE: To present experience with percutaneous balloon-assisted aspi ration thrombectomy (BAT) for the treatment of patients with clotted h emodialysis access grafts. MATERIALS AND METHODS: BAT was performed wi th use of 7-F intravascular sheaths and a Fogarty balloon catheter. It was tested with an in vitro flow-circuit model. Twenty consecutive BA T procedures were performed in 15 patients with clotted grafts, The ba lloon catheter was advanced through the sheath to the arterial anastom osis. The balloon was inflated and withdrawn while suction was applied from the sideport to recover thrombus. The procedure was repeated for the venous limb. BAT was used alone in 12 procedures and in combinati on with urokinase in eight procedures. RESULTS: Almost complete thromb ectomy was achieved in all tubes (in vitro), with very low venous and arterial embolic fractions. Technical success (restored graft thrill a nd almost complete thrombectomy) was achieved in 18 cases (90%). Clini cal success (patency after 1 week of dialysis) was achieved in 17 case s (85%). CONCLUSION: Percutaneous BAT is feasible in recently clotted dialysis grafts.