Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser)

Abstract

A hydrodynamic thrombectomy catheter was prospectively evaluated for the treatment of recently thrombosed vessels. A total of 52 consecutive patients (42 males and 10 females; mean age 64 +/- 15 years) presenting with acute or subacute occlusion of dialysis shunts (n = 25), peripheral bypass (n = 14) or native arteries (n = 15) were treated with the Hydrolyser (Cordis Europa NV, Roden, The Netherlands). Mean occlusion time was 4 days (range 1-17 days) and mean thrombus length 19 +/- 11 cm. The Hydrolyser was effective and fast in removing thrombus, regardless of the thrombus length. No major complications were reported. The immediate procedure success rates were 82, 100, 87 and 79 % for Brescia Cimino, dialysis shunt, native arteries and bypass grafts, respectively. Adjunctive thrombolysis (applied for persistence of residual thrombus or thrombosed distal vessels too small for hydrolytic thrombectomy) was required in 4 % of thrombotic dialysis shunts, in 20 % of native arteries and in 50 % of bypass graft occlusions. On angiographic controls, distal embolizations were reported only in native arteries (13 %) and bypasses (14 %); all were successfully treated percutaneously, except for one case treated by Fogarty balloon. Cumulative primary patency rates were respectively at 6 months 56, 62, 78 and 65 % for each indication. We conclude from this preliminary clinical study that hydrodynamic thrombectomy with a Hydrolyser is a promising technique to treat acute occlusions. This device can reduce complications as well as the time required to remove large amounts of thrombus and the use of expensive thrombolytic drugs.

Hydrodynamic Thrombectomy System versus Pulse-Spray Thrombolysis for Thrombosed Hemodialysis Grafts: A Multicenter Prospective Randomized Comparison

“…On the basis of prior experience with similar thrombus aspiration devices and the results of nonrandomized trials with the current catheter, it was likely that this hydrodynamic thrombectomy system would be at least as effective as pulse-spray thrombolysis in removing fresh thrombus from hemodialysis grafts (12,21). It was also expected that the time to effectively remove the graft thrombus would be shorter than that with thrombolysis owing to the lack of dwell time (12,13,21). Both expectations were met.…”

“…Now several thrombectomy techniques have been introduced clinically or are in trials (4,(7)(8)(9)(10)(11)(12)(13)(14). They promise faster and more efficient thrombus removal, do not subject the patient to the risks of thrombolytic therapy, and apply also to those patients who are not candidates for lysis.…”

Recanalization of Acute and Subacute Femoropopliteal Artery Occlusions with the Rotarex Catheter: One Year Follow-up, Single Center Experience

“…In addition many occlusions are caused by an underlying plaque and/or thrombus, so the ideal thrombectomy device should also be capable of removing organized thrombus [3,16]. Data for MT using rotational recirculation devices which work by the vortex principle or hydrodynamic (rheolytic) recirculation devices report success rates in the lower extremity arteries of 66-90% [1,[7][8][9][17][18][19]; however, adjunctive thrombolysis (usually overnight) was required in 20-42% of cases [1, 7-9, 17, 18]. Rousseau et al reported success for MT alone in 61% of their cases, which was increased to 83% by adding thrombolytic therapy [1,17].…”

“…Data for MT using rotational recirculation devices which work by the vortex principle or hydrodynamic (rheolytic) recirculation devices report success rates in the lower extremity arteries of 66-90% [1,[7][8][9][17][18][19]; however, adjunctive thrombolysis (usually overnight) was required in 20-42% of cases [1, 7-9, 17, 18]. Rousseau et al reported success for MT alone in 61% of their cases, which was increased to 83% by adding thrombolytic therapy [1,17]. Morgan and Belli [1] concluded that mechanical thrombectomy devices are useful for the treatment of thrombosed dialysis grafts but less effective in native arteries and bypass grafts.…”

The use of an occluded femoropopliteal bypass graft to perform angioplasty and stenting.

“…Surgical or percutane ous mechanical thrombectorny [7] of the pa tient's graft should be performed to increase flow across, and help maintain patency of, the stented region. In our particular situation, the re A rterial access is typically ob tamed through the common fern oral artery or the brachial artery in patients whose coagulation profiles are near normal.…”