MANUAL THROMBOASPIRATION AND DILATION OF THROMBOSED DIALYSIS ACCESS -MIDTERM RESULTS OF A SIMPLE CONCEPT

PURPOSE: To report the feasibility, safety, and effectiveness of manua l thromboaspiration as a single means of declotting dialysis access. M ATERIALS AND METHODS: Between April 1994 and December 1996, 59 consecu tive conduits (43 polytetrafluoroethylene [PTFE] grafts, 16 native fis tulas) were declotted with 8-F or 7-F angulated catheters, Unmasked st enoses were dilated, Clinical and paraclinical nephrologic surveillanc e (poor flow, palpation, difficulties with cannulation, increased comp ression times, increasing venous pressures) led to redilations and ste nt placements. Rethromboses were treated with further declotting by as piration. The results are presented according to the life-table method , RESULTS: The initial success of 43 of 43 PTFE grafts (mean procedure time, 119 min +/- 29 [standard deviation]) led to a primary patency r ate of 85% +/- 5% (SE) at 1 month, 33% +/- 8% at 6 months, and 24% +/- 12% at 1 year, A graft was ligated 6 days after declotting for acute bleeding in one patient given high-dose warfarin, The secondary patenc y rates were 86% +/- 7% at 6 months and 86% +/- 9% at 1 year, with a m ean duration of patency of 5.7 months between two radiologic intervent ions performed to maintain or to restore patency, and 19 stents were p laced at a mean follow-up of 3 months, The success rate was 81% for na tive fistulas, with primary patency rates of 81% +/- 10% at 1 month, 7 4% +/- 14% at 6 months, and 60% +/- 27% at 1 year; secondary patency r ates of 81% +/- 12% at 6 months and 81% +/- 18% at 1 year, CONCLUSION: Thromboaspiration is a safe and effective method for declotting dialy sis access, yielding a low rethrombosis rate during the first month, O verall radiologic management with reintervention on average every 6 mo nths results in high secondary patency rates at 1 year (81%-86%).