Comparing Patency Rates of Arteriovenous Dialysis Access following Percutaneous Thrombectomy Using Various Catheter Directed Therapies

Abstract

Arteriovenous fistulas often require frequent interventions to maintain patency for hemodialysis. Interventions may include open or percutaneous thrombectomy with additional targeted interventions as indicated. We evaluated the primary and cumulative functional patency rates following three unique approaches to percutaneous thrombectomy of thrombosed dialysis access. A retrospective review of 236 unique patients who presented with thrombosed hemodialysis access was analyzed over a period of 4 years from 2016-2020. We analyzed a total of 413 procedures that utilized 3 separate percutaneous thrombectomy devices to assist with restoring patency. The Indigo System CAT-D Aspiration Thrombectomy Catheter (Penumbra; Alameda, CA), the Arrow-Trerotola Rotational Thrombectomy System (Teleflex; Wayne, PA) and the Angiojet Rheolytic Thrombectomy Catheter (Boston Scientific, Marlborough, MA) devices were compared for primary and cumulative functional patency. Primary Patency was defined as time from percutaneous thrombectomy to next intervention (Angioplasty, stenting, repeat thrombectomy). Cumulative functional patency was defined as time from percutaneous thrombectomy to time of access abandonment. Medical record chart review was utilized to determine patency rates. A total of 413 percutaneous thrombectomy procedures were performed. Of the procedures performed, 98 utilized Angiojet, 103 utilized Trerotola, and 212 used Penumbra. Mean primary patency rates in (days) for the devices was as follows: Angiojet (194), Trerotola (204), and Penumbra (107). Mean cumulative functional patency rates (in days) for the devices was as follows: rheolytic thrombectomy (450 days), aspiration thrombectomy (292 days), rotational thrombectomy (475 days). Angiojet vs Penumbra and Trerotola vs Penumbra both showed diminished patency rates when using the Penumbra Catheter that were statistically significant (P<.05) CONCLUSION: All percutaneous thrombectomy approaches do not result in the same primary or cumulative functional patency rates. Approaches with Trerotola and Angiojet resulted in improved primary and cumulative functional patency rates compared to those using Penumbra.