MECHANICAL DECLOTTING OF THROMBOSED DIALYSIS GRAFTS - EXPERIENCE IN 86 CASES

PURPOSE: To evaluate the efficacy, safety, and primary patency of perc utaneous mechanical declotting of thrombosed dialysis grafts using lat ex balloons. MATERIALS AND METHODS: Fifty-nine patients with 86 episod es of dialysis graft thrombosis underwent percutaneous mechanical decl otting with balloons using crossing catheter or transjugular technique . Vital signs, peripheral oxygenation, technical success, procedure ti me, and complications were recorded prospectively. Technical success w as defined as a patent graft at the completion of the procedure. Clini cal success, defined as successful dialysis for 1 week, and primary pa tency mere obtained retrospectively from review of the dialysis record s. RESULTS: Technical success was achieved in 74 of 86 procedures (86% ). Median procedure time was 115 minutes, including failed cases. Ten of the 12 technical failures were due to resistant vascular stenoses p recluding graft patency, despite removal of thrombus. There were no im mediate complications. One patient died of sepsis 4 days after declott ing. Clinical success was achieved after 65 of 86 procedures (76%); ni ne grafts thrombosed within 1 week of a technically successful declott ing procedure. Primary patency (including technical failures) was 37% at 3 months, 31% at 6 months, and 17% at 12 months. CONCLUSION: Mechan ical declotting is an effective means of restoring patency to thrombos ed dialysis grafts.