Percutaneous Management of the Thrombosed Dialysis Access Using Arrow-Trerotola Thrombectomy Device: A Single-Center Experience

Objectives: To access thrombosis that frequently occurs in patients with end-stage renal disease (ESRD) on hemodialysis, which requires declotting by various techniques and devices. We review the performance of Arrow-Trerotola™ percutaneous thrombolytic device (PTD) for declotting arteriovenous fistulas and grafts (AVFs and AVGs) at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. Methods: We retrospectively evaluated a total of 38 patients – 19 males (50%) and 19 females (50%) with a median age of 63 years. Twenty-six patients (68%) had an AVF, while 12 patients had an AVG (32%) (18% radiocephalic, 63% brachiocephalic, 16% brachioaxillary, 2% femoral). All patients were treated with mechanical thrombectomy using Arrow-Trerotola device. Technical and clinical success rates as well as primary, primary-assisted, and secondary patency rates were assessed at 3, 6, and 12 months. Results: In our group with a thrombosed AVF or AVG, all were treated using the Arrow-Trerotola device and adjunctive administration of 6 mg of alteplase. Balloon angioplasty and/or stenting were done for the associated stenosis. Our technical success rate was 89%, while the clinical success rate was 79%. The primary patency over 3, 6, and 12 months was 74%, 63%, and 42%, respectively. While the primary-assisted patency was 84%, 79%, and 71%, the secondary patency rates were 84%, 79%, and 74%, respectively. Conclusion: Our experience supports the international published data of the efficacy and safety of Arrow-Trerotola thrombolytic device in the management of thrombosed hemodialysis accesses.

Publication History

Article published online:
26 April 2021