Percutaneous treatment of thrombosed arteriovenous fistulae using the Gelbfish-Endovac aspiration thrombectomy device

Abstract

To study the efficacy and safety of percutaneous treatment of thrombosed hemodialysis arteriovenous fistulae (AVF) using the Gelbfish-Endovac aspiration thrombectomy device (Gelbfish-Endovac). From September 2003 to May 2004, twenty-nine percutaneous thrombectomy procedures were performed in 27 patients (median age of 67 years, 14 females) with thrombosed hemodialysis AVF using the Gelbfish-Endovac. Prior interventions, procedure time, anticoagulation, use of additional devices/thrombolytic agents, technical success, clinical success, complication rates, and patency at 30, 60 and 90 days were evaluated. Sixteen upper arm and 13 forearm AVF were declotted. Seventeen AVF had prior percutaneous interventions. Three AVF had not matured. Median AVF age was 9 months. Heparin was used in 14 procedures. Sixteen arterial lesions and 25 venous lesions were uncovered and treated. Two AVF required the additional use of the Arrow-Trerotola percutaneous thrombectomy device. One AVF underwent side branch ligation. No thrombolytic agents were used. Median procedure time was 70 minutes. Initial technical success was achieved in 24 AVF and clinical success was achieved in 22 AVF. Eleven complications occurred. Ten AVF remained open at 30 days, 10 at 60 days and 8 at 90 days without further interventions. With additional percutaneous interventions, 16 AVF remained open at 30 days, 16 at 60 days and 15 at 90 days. The Gelbfish-Endovac aspiration thrombectomy device is safe and efficacious for percutaneous declotting of AVF.