HYDRODYNAMIC THROMBECTOMY OF HEMODIALYSIS GRAFTS AND FISTULAS - RESULTS OF 51 PROCEDURES

Purpose. To describe efficacy of hydrodynamic thrombectomy for occlude d dialysis native and graft fistulae in 51 instances. Materials and me thods. Fifty-one hydrodynamic thrombectomies of 34 native and graft a- v fistulae were performed. There were 32 thrombectomies in PTFE grafts and 19 procedures in native Brescia-Cimino fistulae. Multiple thrombe ctomies were performed in 11 of 34 fistulae. The estimated occlusion t ime was 36.4+/-22 h. The length of the occluded segment ranged from 2 to 50 cm (mean 28.8 cm). In all cases, a 7 F hydrodynamic thrombectomy catheter was used. Double-cannulation technique was used for graft fi stulae, single-cannulation for native fistulae. Additionally, balloon dilatation was performed in all 51 cases, stenting in six, and aspirat ion thrombectomy in two cases. Results. Arterialized flow was re-estab lished by hydrodynamic thrombectomy and PTA in 43 of 51 cases (84%). B y additional use of other techniques, technical success improved to 46 of 51 procedures (90%). Early re-thrombosis occurred in six cases wit hin 24 h of thrombectomy (11%). Clinical success was achieved in 39 of 46 technically successful cases (85%). Cumulative patency was calcula ted at 63% after 1 week, 57% after 1 month, 48% after 3 months, 37% af ter 6 months, and 32% after 12 months. Patency of native fistulae afte r thrombectomy was better than patency of grafts. Conclusion. Hydrodyn amic thrombectomy is an effective percutaneous technique for declottin g haemodialysis fistulae and grafts recently thrombosed.