DIALYSIS GRAFTS ARTERIAL PLUG - RETRIEVAL USING THE TULIP SHEATH DEVICE IN-VITRO

The ''arterial plug'' is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts following thrombolytic therapy. We studied the physical and morphological charac teristics of the plug and determined the feasibility of transcatheter removal in vitro using the tulip compression thrombectomy system, Sixt een thrombus plugs were recovered during surgical thrombectomy of clot ted human dialysis grafts. The physical and gross physical characteris tics of all plugs were analyzed. Eight specimens were evaluated micros copically. Transcatheter compression thrombectomy of eight plugs was a ttempted in vitro, Each plug was embedded in a polyvinyl tube filled w ith newly clotted blood and connected to a flow circuit. First, balloo n-assisted aspiration thrombectomy (BAT) of soft thrombus was performe d, while sparing the distal-most segment containing the plug. The tuli p sheath was then introduced facing the ''arterial end'' of the tube. The thrombus segment containing the plug was pulled back into the tuli p mesh using either a 3 Fr Fogarty balloon catheter or a self-expandin g rake, The tulip was closed to compress and remove the trapped plug. Near-complete thrombectomy of soft clot was achieved in all tested tub es. Compression and retrieval of the entire arterial plug was successf ul in all except one, where only par tial compression of the plug occu rred, presumably due to fibrotic changes, No fragmentation or emboliza tion occurred in the remaining procedures. Spongy consistency was note d in 94% of the specimens, Microscopic evaluation showed organized lay ered thrombus with compaction in five plugs, Transcatheter removal of a thrombus plug is feasible in vitro using the tulip compression-throm bectomy system.