Single-center Experience with the Arrow-Trerotola Percutaneous Thrombectomy Device in the Management of Thrombosed Native Dialysis Fistulas

Shatsky, Josh B.; Berns, Jeffrey S.; Clark, Timothy W.I.; Kwak, Andrew; Tuite, Catherine M.; Shlansky-Goldberg, Richard D.; Mondschein, Jeffrey I.; Patel, Aalpen A.; Stavropoulos, S. William; Soulen, Michael C.; Solomon, Jeffrey A.; Kobrin, Sidney; Chittams, Jesse; Trerotola, Scott O.

doi:10.1097/01.rvi.0000182157.48697.f5

Cited by 73 publications

(51 citation statements)

References 25 publications

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“…In other studies, urokinase or r-tPA (recombinant tissue plasminogen activator) were used in combination with PTA. The treatment results were similar to those presented in the studies where only PTA was used: PP 18-70%, SP -63-81% [20][21][22][23]. Vascular access through femoral artery and the use of long sheaths to manage AVF may not be widely utilized, but has clear advantages.…”

Section: Pawel Maga Et Al Endovascular Treatment Of Arteriovenous Fsupporting

confidence: 67%

Endovascular treatment of dysfunctional arteriovenous fistula in hemodialyzed patients — the results of one year follow-up

Maga

Krzanowski²,

Kaczmarczyk³

et al. 2017

Acta Angiologica

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Section: Pawel Maga Et Al Endovascular Treatment Of Arteriovenous Fsupporting

confidence: 67%

Endovascular treatment of dysfunctional arteriovenous fistula in hemodialyzed patients — the results of one year follow-up

Maga

Krzanowski²,

Kaczmarczyk³

et al. 2017

Acta Angiologica

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“…Studies examining secondary patency rates as an end point have been published [4,9,10,11,15,16,17]. It is widely believed that patency rates decrease if reocclusionsare treated by a second procedure, but this has never been formally tested.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on dysfunctional fistulas treated radiologically have not identified any medical variables associated with prolonged patency [10, 17]. One study reported that co-morbidities, including diabetes, coronary artery disease and peripheral vascular disease, were associated with twice the risk of losing patency for dysfunctional and thrombosed fistulas, after radiological intervention [16].…”

Section: Discussionmentioning

confidence: 99%

“…It has been estimated that up to 25% of dialysis patient hospitalizations are related to vascular-access-related complications, and the cost of maintenance of the haemodialysis access has exceeded 1 billion USD in the USA [4, 5]. The advent of interventional radiology and a broadening of its applications, including the use of angioplasty, thrombolysis, mechanical thrombectomy and stent insertion, has been increasingly used as first line, to salvage thrombosed conduits, firstly in AVGs and more recently in AVFs [6,7,8,9,10,11]. Turmel-Rodrigues et al [6] reported 12-month primary patency rates of 49, 9 and 14% for forearm fistulas, upper-arm fistulas and prosthetic grafts, respectively, following radiological intervention for thrombosed vascular access.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Early Dialysis Vascular-Access Failure after Thrombolysis

Crikis

Lee²,

Brooks³

et al. 2007

Am J Nephrol

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Background: Vascular-access patency is critical for effective and uninterrupted haemodialysis. Limited literature exists evaluating if a surgical or repeated radiological approach is superior for reocclusion following failure of radiological recanalization. Few consistent early predictors of failure have been identified after radiological intervention for thrombosed vascular access. Methods: 138 patients with thrombosed arteriovenous fistulas or prosthetic grafts treated by radiological intervention, over 10 years, were retrospectively investigated. Reocclusion was treated by either repeated thrombolysis or surgery. Radiological patency rates, after first and second episodes of access thrombosis at 12 months after intervention were analysed. Surgical and radiological patency rates for second access thrombosis were compared. The Cox and logistic regression models were used to identify potential factors associated with reocclusion. Results: In patients who experienced reocclusion within 1 month after radiological intervention, the 3-month repeated radiological patency rate (n = 13) was 38.5%, compared to a 60% surgical patency rate (n = 10), but this did not reach statistical significance. Radiological patency rates after first access thrombosis at 3 and 12 months were 56.6 and 39.5%, respectively. In contrast, radiological patency rates after a second access thrombosis were 51.1 and 24.4%, respectively; a statistical difference in success was not achieved. Native arteriovenous fistulas were 3.23 times as likely to remain patent over 12 months following a first radiological intervention (p < 0.02) and less likely to experience a second reocclusion event (p < 0.01). Anticoagulation was associated with a lower risk of second reocclusion, whilst a history of venous thrombosis was associated with a greater risk (p < 0.02). Conclusion: Surgery achieves superior patency rates compared to repeated radiological interventions and should be considered if reocclusion occurs within a month following radiological thrombolysis.

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“…In the last decade, management of thrombosed AVFs has been largely accomplished by surgical or endovascular interventions. Despite the existence of well established endovascular procedures to declot a thrombosed AVF (2)(3)(4)(5)(6)(7)(8)(9)(10), attempts to salvage these accesses are not universally used.…”

mentioning

confidence: 99%