OCCLUDED HEMODIALYSIS SHUNTS - DUTCH MULTICENTER EXPERIENCE WITH THE HYDROLYSER CATHETER

PURPOSE: To evaluate mechanical thrombectomy of occluded hemodialysis access shunts with a recently developed hydrodynamic device. MATERIALS AND METHODS: Sixty-five thrombosed hemodialysis access shunts were tr eated in 49 patients. The shunts were of three types: Brescia-Cimino f istulas (24 procedures), polytetrafluoroethylene (PTFE; Gore-Tex) loop grafts (18 procedures), and manufactured homologous vein loop grafts (23 procedures). Clots were removed by means of aspiration caused by t he hydrodynamic effect of a high-velocity flow of saline through the c atheter (Venturi effect). RESULTS: Successful declotting was achieved in 58 of 65 (89%) attempts. Early reocclusion occurred in 11 shunts an d was successfully treated by means of repeat thrombectomy in five ins tances. Procedure time averaged 1 - 1 1/2 hours. The primary patency w as similar for the three types of access shunts (P = .09), with a medi an of 14 weeks (including the initial treatment failures). Assisted pa tency for polytetrafluoroethylene loop grafts was better than that for the two other types (P = .002). Complications were encountered in 10 of 65 (15%) cases. These included formation of a large local hematoma that resulted in loss of a Brescia-Cimino fistula, two instances of ar terial embolization, and one case of pulmonary embolization of thrombu s material. CONCLUSION: Effectiveness of mechanical thrombectomy of oc cluded hemodialysis access shunts with the described hydrodynamic devi ce is similar to that of alternative treatments such as thrombolysis.