Vacuum-Assisted Suction Thrombectomy for Salvage of Failing Arteriovenous and Hemodialysis Reliable Outflow Grafts

Abstract

The aim of the study was to determine the safety and feasibility of vacuum-assisted suction thrombectomy for restoring patency to thrombosed hemodialysis reliable outflow (HeRO) and conventional arteriovenous (AV) grafts. Methods: Between December 2016 and August 2017, 11 consecutive patients (6 males, average age 63, and range: 39-80 years) with thrombosed HeRO (n = 7) or AV (n = 5) grafts underwent percutaneous thrombectomy procedures using the Penumbra ® CAT 8 ® or CAT D ® (Alameda, CA, USA) suction thrombectomy catheter as the primary device to clear the venous outflow tract or limb before pulling the arterial plug with a compliant balloon. A total of 21 hemodialysis declot procedures using suction thrombectomy were documented and analyzed. Average procedure length and fluoroscopy time, length of thrombus cleared, blood loss, complications, and primary patency were recorded and compared to the same patient's previous thrombectomy procedures. Results: All procedures were technically successful (100%) at restoring graft patency; however, reocclusion within 5 days occurred in 4 (19.0%) cases. Three (14.3%) interventions required additional balloon maceration or sweep to clear the venous outflow following thrombectomy. Average thrombus length treated by suction thrombectomy measured 21.1 cm (range: 12-27 cm). Average blood loss was 162.6 mL (range: 50-250 mL). No procedure-related complications were recorded. The average procedure length and fluoroscopy time using suction thrombectomy were 74.7 and 14.2 min, respectively, compared with 82.0 and 14.0 min, respectively, in the previous thrombectomy procedures using standard methods (P > 0.05). Conclusion: Vacuum-assisted suction thrombectomy is a safe and feasible method for removing thrombus and restoring patency to thrombosed AV and HeRO grafts.