TREATMENT OF THROMBOSED DIALYSIS ACCESS GRAFTS - RANDOMIZED TRIAL OF SURGICAL THROMBECTOMY VERSUS MECHANICAL THROMBECTOMY WITH THE AMPLATZ DEVICE

PURPOSE: To report the preliminary results in a trial comparing the Am platz mechanical thrombectomy (MT) device with surgical thrombectomy ( ST) to declot occluded dialysis access grafts. PATIENTS AND METHODS: T hirty-seven patients were randomly assigned by computer to either ST ( n = 18) or MT (n = 19), Diagnostic fistulograms were obtained at the e nd of the procedure, and Doppler ultrasound was performed at 1-month f ollow-up, Plasma free hemoglobin levels were measured before, immediat ely after, and 24 hours after the procedure in the MT group, Success w as defined as initial success with restoration of flow through the gra ft, primary patency at 30 days, and secondary patency at 30 days. RESU LTS: Technical success with MT was 89%. Primary patency in the MT seri es was 47% and secondary 30-day patency was 68%, Technical success wit h ST was 83%. Primary patency in the ST series was 77% and secondary p atency at 30 days was 77%, Angioplasty (n = 18) and stent placement (n = 6) were performed in the MT cases, Angioplasty was impossible in on e patient, Immediately after MT, plasma free hemoglobin levels above n ormal were noted in 63% of the cases, but these levels were within nor mal levels after 24 hours in 88% of the cases. CONCLUSION: Initial suc cess of MT in patients with occluded dialysis access grafts is compara ble to that of ST, No statistically significant differences in primary or secondary patencies were seen