Utility of Rotational Thrombectomy for the Management of Thrombosed Arteriovenous Shunts

Objectives: To assess the safety and efficacy of arteriovenous (AV) dialysis shunt thrombectomy utilizing a rotational thrombectomy device in patients with pseudoaneurysms refractory to the conventional “push–pull” method. Methods: Between July 2016 and August 2019, 34 dialysis shunt thrombectomy procedures were retrospectively examined (15 fistulas, 19 grafts) in 29 individual patients (13 males, 16 females, average age 64, and range 35–84). All patients presented with clotted accesses and had pseudoaneurysms that were refractory to angioplasty balloon sweeps (“push–pull”) to restore patency. The Cleaner® rotational thrombectomy device was used as a bail-out in all instances in an attempt to restore patency to the clotted shunt. Procedure success, complications, primary patency, primary-assisted patency, average number of shunt aneurysms, and average aneurysm size were documented and analyzed. Results: Thirty-three (97%) of the thrombectomy procedures were successful in restoring patency and facilitating same-day hemodialysis. An average of 1.5 aneurysms was treated per patient (range 1–3, standard deviation [SD] 0.65) with an average size of 15.0 mm (range 9.4–31.1, SD 4.87). A total of 5 (14.7%) documented postprocedural complications occurred, including one episode of bleeding which prompted activation of a rapid response team. No device-related complications were recorded. Among the 27 patients with follow-up, primary patency averaged 93 days (range 1–488 days) and primary-assisted patency averaged 91.0 days (range 1–564 days). Nine (26.4%) cases resulted in primary patency to the time of data collection. Conclusion: Rotational thrombectomy with the Cleaner® device appeared to be a safe and effective option for restoring patency to thrombosed AV accesses with pseudoaneurysms refractory to standard push–pull techniques with angioplasty balloons.

Publication History

Article published online:
26 April 2021