Ultrasound-guided removal of organized thrombi using biopsy forceps in dialysis patients with arterio-venous access occlusion

Abstract

Introduction: As a countermeasure against the organized thrombi frequently observed in vascular access occlusion, we devised a percutaneous excision method for organized thrombi under superficial ultrasound guidance using biopsy forceps. The Radial JawTM 3 (2 mm) biopsy forceps of Boston Scientific Corporation was used. The usefulness of this method was investigated. Method: The following protocol, which is suitable for endovascular treatment, was prepared and used: (1) all procedures were performed under ultrasound guidance and (2) use of the forceps was assisted via a long sheath in cases involving a complicated bloodstream. Subjects: Among 564 cases of arterio-venous access occlusion that received treatment at this hospital between May 2014 and April 2017, the subjects of this study were 468 cases who could be followed up. Thrombectomy of an organized thrombus using the biopsy forceps was performed 194 times in 138 cases. Biopsy forceps were used in the initial treatment in a total of 115 cases, including 71 cases of acute occlusion of an autologous vein, 3 cases of chronic occlusion of an autologous vein, and 41 cases of acute occlusion of a prosthetic vessel. Results: The initial success rate for all cases of occlusion was 97.2%. The initial success rate for cases in which biopsy forceps were used was 98.2%. For cases using biopsy forceps, the primary patency rates were 47.1% at 3 months, and the secondary patency rates (until occlusion) were 89.1% at 3 months. Conclusion: This method was considered to be a valuable choice as a countermeasure against organized thrombi.