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Endovascular Revascularization of Hemodialysis Thrombosed Grafts with the Hydrodynamic Thrombectomy Catheter. Our 7-Year Experience

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Abstract

Purpose

To evaluate the efficacy and safety of the hydrodynamic thrombectomy catheter (AngioJet DVX) in the salvage of thrombosed hemodialysis vascular grafts.

Materials and Methods

A retrospective study was designed, including all patients with occluded arteriovenous grafts treated with the AngioJet system between 2007 and 2014 in our institution. Outcomes included technical success, clinical success, complications, and primary and secondary patencies. Procedural success was defined as angiographic confirmation of flow restoration, the presence of a pulsatile thrill along the graft, and successful resumption of at least one hemodialysis session. Primary and secondary patencies after first AVG thrombectomy were calculated with Kaplan–Meier curves. Cox regression was used to determine prognostic factors of primary patency after every thrombectomy episode.

Results

A total of 149 thrombectomies were performed in 68 grafts. After thrombectomy, endovascular treatment of one or more stenosis was performed in all cases. Technical success was 93% and clinical success was 86%. Complications occurred in 7 thrombectomies, most of them were minor except for one anastomosis rupture requiring surgery. Primary and secondary patencies were 52, 41, and 23 and 76, 68, and 57% at 3, 6 and 12 months, respectively. Independent prognostic factors of poor patency after every thrombectomy episode were the presence of residual thrombus (OR 1.831, P = 0.008) and time from last thrombosis (less than 1 month; and OR 7.116, P < 0.001).

Conclusion

Percutaneous mechanical thrombectomy with AngioJet is a safe technique with a high-clinical success rate. The presence of residual thrombus after thrombectomy and early re-occlusions are related to poorer results.

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Funding

Funding was provided by Boston Scientific Corporation, Terumo BCT, and W. L. Gore.

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Authors and Affiliations

  1. Vascular and Interventional Radiology Unit, Diagnostic Imaging Institute, Clinic Hospital of Barcelona, Barcelona, Spain

    Patrícia Bermudez, Andres García-Gámez, Marta Barrufet, Marta Burrel, Rosa Gilabert, Fernando Gómez & Juan Macho

  2. Vascular Access Unit, Nephrologic and Urologic Diseases Clinical Institute, Clinic Hospital of Barcelona, Barcelona, Spain

    Nestor Fontseré

  3. Cardiovascular Diseases Institute, Clinic Hospital of Barcelona, Barcelona, Spain

    Gaspar Mestres

Authors
  1. Patrícia Bermudez
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  2. Nestor Fontseré
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  3. Gaspar Mestres
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  4. Andres García-Gámez
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  5. Marta Barrufet
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  6. Marta Burrel
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Correspondence to Patrícia Bermudez.

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Conflict of interest

Gaspar Mestres, Marta Barrufet and Marta Burrel declare personal fees from W.L. Gore & Associates, Boston Scientific, and Terumo, outside the submitted work. Patrícia Bermudez, Nestor Fontseré, Andres García-Gámez, Rosa Gilabert, Fernando Gómez, Juan Macho have nothing to disclose.

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For this type of study, formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Bermudez, P., Fontseré, N., Mestres, G. et al. Endovascular Revascularization of Hemodialysis Thrombosed Grafts with the Hydrodynamic Thrombectomy Catheter. Our 7-Year Experience. Cardiovasc Intervent Radiol 40, 252–259 (2017). https://doi.org/10.1007/s00270-016-1488-x

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