Managing Arrow-Trerotola Percutaneous Thrombolytic Device Complications

Abstract

Dialysis access interventions are frequently performed by interventional radiologists. Several commercially available percutaneous thrombolytic devices can help restore patency to thrombosed arteriovenous access circuits. The Arrow-Trerotola Percutaneous Thrombolytic Device is one such device, and has a long track record of safe and effective use. However, like any medical device, complications can occur during its use. This article describes three complications and associated management strategies utilizing fundamental interventional radiology techniques of balloon tamponade, stent placement, and snare mediated foreign body retrieval.

Keywords

dialysis interventions - venous rupture - foreign body retrieval - interventional radiology

Disclosure

R.O.S. and A.J.L. have nothing to disclose. R.C.G. received research funding from the Guerbet USA, the U.S. Department of Defense, and from the NIH.

• References

• 1 Saran R, Li Y, Robinson B. , et al. US Renal Data System 2015 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2016; 67 (03) (Suppl. 01) S1-S305
• 2 Lok CE, Foley R. Vascular access morbidity and mortality: trends of the last decade. Clin J Am Soc Nephrol 2013; 8 (07) 1213-1219
• 3 Trerotola SO, Vesely TM, Lund GB, Soulen MC, Ehrman KO, Cardella JF. ; Arrow-Trerotola Percutaneous Thrombolytic Device Clinical Trial. Treatment of thrombosed hemodialysis access grafts: Arrow-Trerotola percutaneous thrombolytic device versus pulse-spray thrombolysis. Radiology 1998; 206 (02) 403-414
• 4 Trerotola SO, Davidson DD, Filo RS, Dreesen RG, Forney M. Preclinical in vivo testing of a rotational mechanical thrombolytic device. J Vasc Interv Radiol 1996; 7 (05) 717-723
• 5 Dupaix R, Mohan PP. Trerotola device fragmentation. Cardiovasc Intervent Radiol 2017; 40 (04) 636-638
• 6 Hong YK, Kang KH, Kim TH, Yang HC. Vein rupture by Arrow-Trerotola percutaneous thrombolytic device in a treatment of thrombosed arteriovenous graft. J Vasc Access 2018; 19 (04) 396-397
• 7 D'cruz RT, Leong SW, Syn N. , et al. Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: a systematic review and meta-analysis. J Vasc Access 2018 ; doi: 10.1177/1129729818814466 [Epub ahead of print]
• 8 Jones RG, Willis AP, Tullett K, Riley PL. Results of stent graft placement to treat cephalic arch stenosis in hemodialysis patients with dysfunctional brachiocephalic arteriovenous fistulas. J Vasc Interv Radiol 2017; 28 (10) 1417-1421
• 9 Miller GA, Preddie DC, Savransky Y, Spergel LM. Use of the Viabahn stent graft for the treatment of recurrent cephalic arch stenosis in hemodialysis accesses. J Vasc Surg 2018; 67 (02) 522-528
• 10 Rajan DK, Falk A. A randomized prospective study comparing outcomes of angioplasty versus VIABAHN stent-graft placement for cephalic arch stenosis in dysfunctional hemodialysis accesses. J Vasc Interv Radiol 2015; 26 (09) 1355-1361
• 11 Shawyer A, Fotiadis NI, Namagondlu G. , et al. Cephalic arch stenosis in autogenous haemodialysis fistulas: treatment with the Viabahn stent-graft. Cardiovasc Intervent Radiol 2013; 36 (01) 133-139
• 12 Kim HM, Kim HC, Woo S, Son KR, Jae HJ. Disconnection of the rubber tip of Arrow-Trerotola percutaneous thrombolytic device. Korean J Radiol 2014; 15 (02) 254-257