Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: Follow-up study

PURPOSE: To evaluate the feasibility, efficacy, and safety of mechanical th rombectomy of occluded dialysis access with use of a rotating mini-pigtail catheter, MATERIALS AND METHODS: Thrombus was fragmented by mechanical action of the rotating pigtail tip (5-mm diameter), while the guide wire exited a sidehol e at the pigtail curvature and served as a fixed rotation axis. Twenty-six procedures were performed in 22 patients (12 men, 10 women; mean age, 55.5 years), Native fistulas were treated in 15 instances, polytetrafluoroethyle ne (PTFE) grafts were treated in 11 instances. Average occlusion time was 2 0 hours +/- 13 (range, 5-46 hours), average occlusion length was 25.6 cm +/ - 10.1 (range, 6-45 cm), Thrombus fragmentation was followed by baboon angi oplasty of underlying stenoses, RESULTS: In all 26 procedures, the dialysis access was successfully declott ed with subsequent dialysis using the access (clinical success rate, 100%), Handling of the mini-pigtail catheter was simple and rapid, regardless of whether a graft or a native fistula was treated. Average duration of the in tervention was 118 minutes +/- 30, Mean primary patency was 165 days +/- 16 7, Primary patency rate was 82% at 30 days, 65% at 3 months, and 47% at 6 m onths. There was no evidence of complications due to the thrombus fragmenta tion procedure. CONCLUSION: The results suggest that declotting of occluded dialysis grafts and fistulas with the mini-pigtail catheter is as effective and safe as ot her more established percutaneous therapies. It may serve as an easy-to-han dle, low-budget alternative to current thrombectomy devices.