Mechanical thrombectomy in hemodialysis access shunts using a 5F pigtail rotation catheter - In vitro and in vivo investigations

RATIONALE AND OBJECTIVES. TO evaluate the feasibility of mechanical thrombe ctomy in occluded hemodialysis access shunts by using a newly developed 5F pigtail rotation catheter, METHODS. Thrombosed hemodialysis access shunts were simulated by clotted bo vine blood in silicone tubing (diameter 6 mm). After retrograde and antegra de sheath placement (6F), mechanical fragmentation was performed using a 5F rotatable pigtail device. Average tube length was 27 to 47 cm; average thr ombus weight was 5 to 11.9 g (8.2 +/- 1.59). Clinical application involved six patients with fresh shunt occlusions (three Brescia-Cimino shunts, thre e Gore-Tex shunts). RESULTS. Using the in vitro setup, the device was able to restore a continu ous lumen within 10 minutes with no remaining wall-adherent thrombi, The av erage amount of particles in the effluent was 3.0 g (2.0 to 3.9) for partic les less than or equal to 1.0 mm and 0.67 g (0.44 to 0.96) for particles gr eater than or equal to 0.2 mm wet weight; (compared with initial thrombus w eight, 30.7% and 1.1%, respectively). Clinically, all six hemodialysis acce ss shunts were successfully recanalized, Technical problems did not occur. There were no clinical symptoms indicating pulmonary embolism in any of the treated patients. CONCLUSIONS. In our experimental setup as well as under clinical conditions , effective treatment of occluded hemodialysis access sites was achieved. T he pigtail rotation device is an easy-to-handle, inexpensive alternative to mechanical thrombus fragmentation in occluded hemodialysis access shunts. The rate of emboli in the effluent vein of approximately one third of the i nitial thrombus weight must be taken into consideration in frequent intrain dividual use of this technique.