Is there an optimal interventional device for the salvage of thrombosed native angioaccess for hemodialysis?

Abstract

Evaluation of: Yang CC, Yang CW, Wen SC, Wu CC. Comparisons of clinical outcomes for thrombectomy devices with different mechanisms in hemodialysis arteriovenous fistulas. Catheter Cardiovasc. Interv. doi:10.1002/ccd.24408 (2012) (Epub ahead of print).The rescue of autogenous angioaccess for hemodialysis can be performed surgically or radiologically. For the latter, there is current debate as to whether a mechanical hydrodynamic device confers a clinical advantage over a rotational thrombectomy. The evaluated article describes a single center retrospective cohort study (275 procedures in 213 patients) assessing the observed outcomes of the AngioJet mechanical and hydrodynamic mechanism versus the rotational percutaneous thrombectomy device (PTD; Arrow-Trerotola). Outcomes measured were complications arising, as well as primary and secondary patency rates. The time taken to perform the PTD method was significantly shorter than for the AngioJet. Despite no significant difference seen between the two techniques for 6-month primary patency (43% PTD vs 45% AngioJet), secondary patency was significantly greater in PTD compared with AngioJet (74 vs 87%, p = 0.01). The authors conclude that the rotational mechanism device was faster and associated with a higher secondary patency rate.