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CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2020; 4(02): 087-091
DOI: 10.4103/AJIR.AJIR_8_20
Original Article

Dialysis Shunt Thrombectomy Utilizing a Rotational Thrombectomy Device in Patients with Pseudoaneurysms

Anderson Webb
Departments of Radiology, University of Chicago Medical Center, Chicago, IL, USA
,
Kurt Zacharias
Departments of Radiology, University of Chicago Medical Center, Chicago, IL, USA
,
Paul Ciolek
Department of Radiology, University of Chicago, Chicago, IL, USA
,
Thomas Webb
Department of Radiology, Belmont University, Smithville, TN, USA
,
Osman Ahmed
Interventional Radiology, University of Chicago Medical Center, Chicago, IL, USA
› Author Affiliations Financial support and sponsorship Nil.
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Aims: To assess the safety and efficacy of dialysis shunt thrombectomy utilizing a rotational thrombectomy device in patients with pseudoaneurysms refractory to declot by conventional treatments. Methods: Between July 2016 and August 2019, 34 dialysis shunt thrombectomies were retrospectively examined in 29 individual patients. All patients presented with pseudoaneurysms and clotted accesses that were refractory to angioplasty balloon sweeps (“push–pull”) to restore patency. The Cleaner® rotational thrombectomy device was used as a bail-out in an attempt to restore patency to the clotted shunt. Procedure success, complications, primary patency, primary-assisted patency, secondary patency, average number of shunt pseudoaneurysms, and average pseudoaneurysm size were documented and analyzed. Results: Thirty-three of the 34 (97%) thrombectomies were successful in restoring patency and facilitating same-day hemodialysis. An average of 1.5 pseudoaneurysms were present per patient (range 1–3 pseudoaneurysms, standard deviation [SD] 0.65 pseudoaneurysms), with an average size of 15.0 mm (range 9.4–31.1 mm, SD 4.87 mm). Postprocedural complications occurred in 14.7% of the cases, none of which were definitively device related. Primary patency to the time of data collection was achieved in 29% of the cases, and the average primary patency for these cases was 124.5 days (range 10–946 days, SD 186.9 days). The average primary-assisted patency was 126.8 days (range 1–564 days, SD 169.8 days). Dialysis accesses were eventually abandoned or surgically revised in ten instances, resulting in an average secondary patency of 157.5 days (range 6–712 days, SD 257 days). Conclusions: In patients with pseudoaneurysms, rotational thrombectomy with the Cleaner® device appeared to be a safe and effective option for restoring patency to thrombosed dialysis accesses refractory to standard push–pull techniques with angioplasty balloons.

Dialysis intervention - patency - pseudoaneurysm - shunt - thrombectomy


Publication History

Received: 02 April 2020
Received: 25 April 2020

Accepted: 14 May 2020

Article published online:
26 March 2021

© 2020. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. https://creativecommons.org/licenses/by-nc-nd/4.0/.

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