Percutaneous Thrombectomy Device Research Articles

Initial experience of thrombectomy using vascular snare with multiple loops for chronic organized thrombi in patients with thrombosed native hemodialysis fistulas.

Thrombi in native hemodialysis access frequently exhibit chronic organized feature because they have formed over a long period. Removal of these is quite difficult owing to relatively large volume, resilient feature, limitations of the introducer sheath size, etc. In this study, we report our experience using a vascular snare for the removal of these thrombi in native arteriovenous fistula (AVF). The medical records of patients who underwent recanalization for thrombosed AVFs from January 2019 to August 2023 were reviewed. During the study period, a total of 29 native fistulas (19 brachiocephalic, nine radiocephalic, and one radiobasilic) in 25 patients were treated using a vascular snare with multiple loops (19 men and six women). Characteristics of the AVFs, endovascular procedures, technical and clinical results, and complications were evaluated. Anatomic and clinical success rates were 96.6% and 100%, respectively. Total thrombosis was observed in 21 (72.4%) fistulas. Aneurysmal changes were found in 22 (75.9%) fistulas. The mean fistula age at the time of the procedure was 60.9 months (standard deviation, 52.2). Thrombectomy was initiated using a vascular snare in 14 fistulas. In 15 fistulas for which the procedures were initiated using a rotational percutaneous thrombectomy device (PTD), a vascular snare was subsequently used because recanalization failed or was insufficient due to chronic organizing thrombi. Additional aspiration and balloon angioplasty were performed in 27 (93.1%) and 28 (96.6%), respectively. Pharmacological thrombolysis was performed in one fistula for long segmental thrombosis combined with arterial thrombosis. The mean procedure time, excluding thrombolysis, was 91.9 min (standard deviation, 55.5). No complications related to the use of the vascular snare was observed. The use of a vascular snare with multiple loops was safe and highly effective for the removal of chronic organized thrombi in the recanalization of thrombosed AVFs.

A swine model of pulmonary embolism with human-derived thrombi

Objectives: The development and evaluation of percutaneous thrombectomy devices for pulmonary embolism (PE) pose a need for standardized large in vivo models with representative anatomical and physiological conditions and clots analogs. In this study, we present a swine model of PE model employing human-derived clot analogs. Material and Methods: Baseline angiographic and physiological pressure measurements were obtained in six adult Yorkshire pigs (45–65 kg) and results were benchmarked for interspecies comparison with published human data using fluoroscopic examinations, intra-arterial pressure measurements, and histologic studies. Then, clot analogs were created ex vivo employing banked human blood and a subset incubated in iodinated contrast for fluoroscopic visualization. Clot analogs were then embolized via a femoral venous access and angiographic/physiological consequences were evaluated. Results: The main, right, and left pulmonary artery diameters were 24 ± 1.1 mm, 16.5 ± 0.8 mm, and 12.6 ± 1.2 mm, respectively. The angle between the main pulmonary artery at the bifurcation point was approximately 90–95°. The clot analogs were heterogeneous and had increased fibrin content along the clot length. The overall composition was 96.63% red blood cell (RBC)/3.37% fibrin in the initial section, 48.85% RBC/51.15% fibrin in the intermediate section, and 3.44% RBC/96.56% fibrin in the final section. Embolization of the clot analogs resulted in distal occlusion of the right and left pulmonary arteries. Conclusions: This swine model coupled with clot analog is able to accurately mimic human anatomical and physiological conditions in PE making it feasible for the evaluation of pulmonary thrombectomy devices.

Successful Percutaneous Mechanical Suction Thrombectomy of Extracorporeal Filtration System Following Bilateral Lung Transplantation Secondary to COVID-Pneumonia

IntroductionCOVID infections show increased risk of thromboembolic events. We report a case of a 43 year old male with acute Covid-19 pneumonia necessitating veno-venous ECMO and RVAD support as bridge to pulmonary transplantation. At transplant, he had thrombus along his extra-corporeal pulmonary artery cannula necessitating percutaneous mechanical thrombectomy.Case ReportThe patient presented as a transfer to our institution with COVID-19 related ARDS in refractory respiratory failure with multiple bronchopleural fistulas. Shortly after admission, veno-venous ECMO was initiated and over time was fully ECMO dependent due to extensive tissue destruction with essentially no functional lung tissue. He was converted to right internal jugular-left subclavian vein ECMO-RVAD configuration while assessing for transplantation. After 135 days of support, a suitable donor was identified and was taken for bilateral lung transplantation with ECMO/RVAD support. This was complicated by a frozen chest, massive transfusion, and primary graft dysfunction necessitating postoperative maintenance of circulatory support. Intraoperatively, a large thrombus burden was found along the pulmonary artery outflow cannula. His chest was left open at that time while his graft recovered. Three days later, a percutaneous suction thrombectomy device was inserted through his right femoral vein and under TEE guidance, he underwent suction thrombectomy of the pulmonary artery cannula clot burden (Figure 1). He was decannulated and underwent chest closure thereafter. He was anticoagulated post-operatively and has not had any further thromboembolic events.SummaryAcute COVID-19 infection leads to a known increased risk of thromboembolic phenomena. We present an interesting approach to removal of ECMO-cannula associated thrombus in severe SARS-CoV-2 infection necessitating bilateral lung transplantation.

Treatment of Symptomatic Paravisceral Aortic Thrombus Using Percutaneous Suction Thrombectomy

Paravisceral aortic thrombus in an otherwise normal aorta is rare. A hemodynamically significant thrombus burden in such patients can result in visceral malperfusion and bilateral lower extremity ischemia, both of which, historically, have a high mortality rate. Open thrombectomy via a thoracoabdominal approach is associated with high mortality. Other endovascular alternatives, including Fogerty embolectomy and mechanical thrombectomy, are associated with visceral embolization. The Penumbra CAT-12 lightning device (Penumbra Inc, Alameda, Calif) most commonly used to treat ileofemoral deep vein thrombosis is a 12F suction catheter with the ability to remove large amounts of clot burden with minimal blood loss owing to its sensor mechanism. The ability to suction thrombectomy-focused areas in the aorta reduces the likelihood of embolization. We have presented the cases of two patients with acute symptomatic paravisceral aortic thrombus who were treated with this device and their outcomes. Two patients had presented to the emergency room with acute onset abdominal pain and bilateral lower extremity rest pain and numbness. Patient 1 was a 46-year-old woman with antithrombin III and protein C deficiency (Fig 1). Patient 2 was a 78-year-old woman with recent coronavirus disease 2019 infection, chronic obstructive pulmonary disease, and congestive heart failure (Fig 2). Computed tomography angiography of patients demonstrated aortic thrombus in the paravisceral aorta extending from the supraceliac to the infrarenal aorta. Both patients underwent percutaneous suction thrombectomy of the aorta using the Penumbra CAT-12 lightning device. Patient 2 also underwent bilateral femoral cutdown, thrombectomy, and kissing iliac stents, followed by diagnostic laparoscopy without any further intervention. The intraoperative angiographic images demonstrated the initial aortic thrombus in the paravisceral aorta with resolution of thrombus after suction thrombectomy (Figs 1 and 2). The abdominal pain and bilateral lower extremity rest pain had resolved in both patients postoperatively and did not require any further surgical intervention. Patient 1 was discharged home on postoperative day 3. Patient 2 was discharged to a rehabilitation facility on postoperative day 10. Percutaneous suction thrombectomy devices such as the Penumbra CAT-12 lightning device is effective in removing a large paravisceral aortic clot burden without any embolization to the visceral vessels. This is a newly available alternative to consider for such patients with symptomatic paravisceral aortic thrombus considered to have a high mortality risk with open intervention.Fig 2a, Angiogram demonstrating aortic thrombus at the level of the superior mesenteric artery. b, Coronal view of paravisceral aortic thrombus. c, Abdominal aortogram demonstrating improvement in paravisceral thrombus burden with embolization of thrombus to the aortic bifurcation. d, Lateral aortogram demonstrating patent and disease-free celiac and superior mesenteric artery. e, Aortogram after bilateral femoral embolectomy and bilateral kissing iliac stents showing flow to the lower extremity and pelvis restored with no further thrombus burden. f, Post-op CTA demonstrating aortic lumen patency at the SMA take-off.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Percutaneous Thrombectomy Using the ClotTriever Device for Acute Iliofemoral Deep Venous Thrombosis

Iliofemoral deep venous thrombosis (DVT) is associated with significant short- and long-term morbidity. Early thrombus removal is postulated to prevent the development of post-thrombotic syndrome by restoring unobstructed deep venous flow. Pharmacomechanical thrombolysis may be prohibitive in select patients with significant bleeding risks. The novel percutaneous thrombectomy device (ClotTriever; Inari Medical, Irvine, Calif) can minimize or even alleviate the need of thrombolytics while restoring venous patency. Patients who underwent percutaneous venous thrombectomy using the ClotTriever device for iliofemoral DVT between 2019 and 2020 were identified. Baseline demographics, risk factors, presenting symptoms, and perioperative outcomes were recorded. Technical success was defined as complete thrombus resolution based on venography or intravascular ultrasound. Major bleeding was defined as the need for blood transfusion, surgical reintervention, or intracranial hemorrhage. Ten patients were identified during the study period. Mean age was 62.8 years (range, 42-79 years). There were seven men and three women. All patients had iliofemoral DVT and four patients had clot extension into the vena cava. Four patients had one or more underlying risks factors for venous thrombosis and two patients had contraindications to the use of thrombolytics. Eight patients presented with debilitating lower extremity venous congestion and two patients with phlegmasia cerulea dolens. Popliteal access was used for device insertion in 100% of patients. In four patients, catheter-directed thrombolysis was initially used but was found to be unsuccessful, thus necessitating the use of percutaneous thrombectomy. Intravascular ultrasound was used and concomitant venous stenting was used in three patients. Technical success, defined as complete clot resolution, was achieved in 100%. Immediate symptom resolution was also achieved in all 10 patients. Two patients required postintervention blood transfusions, one patient for a non-procedure-related retroperitoneal hematoma and the other for asymptomatic anemia. The ClotTriever venous thrombectomy system is effective at restoring caval and iliofemoral patency in the acute setting with or without the need for adjunctive catheter-directed thrombolysis. The theoretical benefits of this new technique include a shorter length of stay in the intensive care unit, avoidance of lytic therapy, and quicker recovery. The safety and effectiveness of these devices have yet to be defined. Comparative studies with current pharmacomechanical techniques are required.

Effectiveness and Safety of Percutaneous Thrombectomy Devices: Comparison of Rotarex and Angiojet in a Physiological Circulation Model

To compare the percutaneous Rotarex and Angiojet thrombectomy devices with regard to effectiveness and invitro safety. The Rotarex and Angiojet devices were evaluated in an established invitro pulsatile flow model with a human femoropopliteal vessel phantom. First pass recanalisation and thrombus weight were assessed after thrombectomy, as well as micro- and macro-emboli. Further, histological evaluation of the vascular phantom was performed to analyse vascular injuries. Thrombus weight did not differ significantly prior to the thrombectomy between the groups, but the Rotarex showed slight advantages in thrombus removal vs. the Angiojet regarding first pass recanalisation. Micro- and macro-emboli occurred in most of the endovascular manoeuvres performed; however, significantly more macro-emboli (2.37±1.51 vs. 0.87±0.83; p=.048) were observed using the Rotarex than the Angiojet. Macroscopic dissections were detected in the Rotarex group (n=3) but not in the Angiojet group. Microscopic vascular injuries were detected significantly more often in the Rotarex group (Rotarex: 531.61μm±102.81μm; Angiojet: 705.42μm±61.68μm [p=.001]). Both devices showed a comparable performance, with a slight advantage for the Rotarex regarding first pass recanalisation. Significantly more thrombo-emboli, and vascular injuries were observed in the Rotarex group with the latter being obviously the more tissue preserving procedure but potentially with a lower rate of recanalisation. Based on the present results, clinical randomised trials, including long term follow up, are needed to optimise and improve the use of catheter based procedures, taking into account the thrombus entity, localisation, and clinical history.

Safety and effectiveness of CATCH+ as a first-line device for revascularization in the treatment of acute ischemic stroke

PurposeMechanical thrombectomy devices and stent retrievers have recently been advocated for use as first-line therapy in acute ischemic stroke. Here we evaluate the safety and effectiveness of the CATCH+ stent retriever as a percutaneous thrombectomy device. MethodsA retrospective analysis was performed on 101 consecutive patients who presented with anterior or posterior intracranial vessel occlusion and were treated with the CATCH+ intracranial system, either alone or in combination with intravenous tissue plasminogen activator, at a single treatment center. The primary outcome measure was successful post-procedural reperfusion as classified by the mTICI score. Secondary endpoints included mortality rate, incidence of adverse events, and functional outcomes evaluated at discharge using the mRS score. ResultsSixty-nine (68.3%) patients received thrombolysis prior to mechanical thrombectomy. Successful reperfusion (mTICI≥2b) was achieved in 73.3% of patients at the end of the procedure, and good functional outcomes (mRS≤2) were observed in 32.7% of patients at discharge. Three patients developed asymptomatic subarachnoid hemorrhage, two developed asymptomatic dissections of the internal carotid artery, and one patient developed a symptomatic intracranial hemorrhage. Seventeen patients died (mortality rate 16.8%). ConclusionsThe CATCH+ device is a safe and effective mechanical thrombectomy device for the first-line treatment of acute ischemic stroke.

VH05. Novel Percutaneous Thrombectomy Device for the Management of Lower Extremity Deep Venous Thrombosis

This video describes the technique of a novel percutaneous thrombectomy device for the management of deep venous thrombosis. It has clinical pictures as well as venograms before and after intervention in addition to images of the device while the thrombectomy is being performed. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI5OGZlOWIyNGQ3YWIzNTNlYWI0NWNlNjUzNDNkYzc2MyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4ODI3Mjk4fQ.j5_8vrqGIIwNW3qhJqXNQhyBLkuj4EmUHX7PjpPmOIFnuzhhzQo2lwHSdHd7Q1I5ShirPphF2SNrcEGorHxQ1EJezHLy-OwpR7ce4_ZlxXT8ifl0N240fLf2mhvGt8kUYmd_fAGrgnSuVZF61X093vb0c-omcTByhqn8PdyeVgBmQDzu-YmWb660uTGbKQKVbTkbfJVHggYpV7j6dNHiLan_nJK68jwQeCOVIjg1P6ABUBLTVVf9UxDU6MMnATxKaEbGszzC7W2pjPqb8kJrgwXgrG-oMSquL6Iq7FBAwn9u3polvH_tjSbZCYL_ITjJK0t8zmQeHhDugyZLl551Bg Download .mp4 (48.55 MB) Help with .mp4 files Video

Interventional Radiology-Operated Cholecystoscopy for the Management of Symptomatic Cholelithiasis: Approach, Technical Success, Safety, and Clinical Outcomes.

The objective of our study was to report the technique, complications, and clinical outcomes of interventional radiology-operated cholecystoscopy with stone removal for the management of symptomatic cholelithiasis. Ten (77%) men and three (23%) women (mean age, 65 years) with symptomatic cholelithiasis underwent cholecystostomy followed by interventional radiology-operated cholecystoscopy with stone removal. Major comorbidities precluding cholecystectomy included prior cardiac, pulmonary, or abdominal surgery; cirrhosis; sepsis with hyponatremia; seizure disorder; developmental delay; and cholecystoduodenal fistula. Cholecystostomy access, time between cholecystostomy and cholecystoscopy, endoscopic and fragmentation devices used, technical success, procedure time, fluoroscopy time, complications, length of hospital stay, time between cholecystoscopy and cholecystostomy removal, follow-up, and acute cholecystitis recurrence were recorded. Eleven (85%) patients underwent transhepatic cholecystostomy, and two (15%) patients underwent transperitoneal cholecystostomy. The mean time from cholecystostomy to cholecystoscopy was 151 days. Flexible endoscopy was used in eight (62%) patients, rigid endoscopy in three (23%), and both flexible and rigid in two (15%). Electrohydraulic lithotripsy was used in eight procedures, nitinol baskets in seven, ultrasonic lithotripsy in two, and percutaneous thrombectomy devices in one. Primary technical success was achieved in 11 (85%) patients, and secondary technical success was achieved in 13 (100%) patients. The mean procedure time was 164 minutes, and the mean number of procedures required to clear all gallstones was 1. One (8%) patient developed acute pancreatitis, and one (8%) patient died of gastrointestinal hemorrhage. The median hospital length of stay after cholecystoscopy was 1 day for postoperative monitoring. The mean time between cholecystoscopy and cholecystostomy removal was 39 days. One (8%) patient developed recurrent acute cholecystitis 1095 days after cholecystoscopy. Interventional radiology-operated cholecystoscopy may serve as an effective method for percutaneous gallstone removal in patients with multiple comorbidities precluding cholecystectomy.

The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis

Objective To evaluate the clinical safety and effectiveness of percutaneous rheolytic thrombectomy in patients with acute lower extremity deep venous thrombosis. Method Sixty-eight consecutive patients with acute massive lower extremity deep venous thrombosis were included in this retrospective study. A percutaneous rheolytic thrombectomy device (Angiojet ® Rheolytic thrombectomy catheter, Boston Scientific, Marlborough, MA, USA) was used in all patients in an angiography suite through ipsilateral popliteal vein access. Thrombus clearance and complications were evaluated. Furthermore, patients underwent a clinical evaluation according to a modified Villalta scale for the investigation of post thrombotic syndrome in follow-up. The Venous Clinical Severity Score, Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym questionnaires were completed preoperatively and readministered postoperatively. Results Overall thrombus clearance (complete recanalization was achieved in 58 patients (85.2%) and partial recanalization was achieved in 7 patients (10.2%) confirmed through venographic assessment was achieved in 95.5% of the patient population. The mean Venous Clinical Severity Score preoperatively was 13.1 ± 2.2 and decreased to 4.0 ± 1.3 postoperatively (P < 0.01). The Villalta scale dropped from 12.9 ± 2.8 to 5.5 ± 1.4 postoperatively (P < 0.001). Overall quality of life and symptoms improved as assessed by Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym (P < 0.01 and 0.02, respectively). Only three minor bleedings were seen but none of the patients suffered from major bleeding, symptomatic pulmonary embolism, death, or other procedure related complications. Fifty-nine out of 65 patients (90.7%) who were treated successfully with rheolytic thrombectomy remained patent at 12 months according to DUS and five patients (7.3%) developed a mild post thrombotic syndrome. Conclusion Rheolytic thrombectomy with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. This technique is a safe, effective and easily performed method of endovascular treatment with a low rate of major treatment complications and shows promising clinical mid-term results.

176-59: Percutaneous Vacuum-Assisted Thrombectomy Device Used for Removal of Large Vegetations on Infected Pacemaker and Defibrillator Leads as an Adjunct to Lead Extraction

176-59: Percutaneous Vacuum-Assisted Thrombectomy Device Used for Removal of Large Vegetations on Infected Pacemaker and Defibrillator Leads as an Adjunct to Lead Extraction

Percutaneous Vacuum-Assisted Thrombectomy Device Used for Removal of Large Vegetations on Infected Pacemaker and Defibrillator Leads as an Adjunct to Lead Extraction.

This case series reports our early experience with a minimally invasive percutaneous method of safely removing large vegetations during lead extraction in septic cardiac implantable electronic devices (CIED). Debate exists concerning the management of vegetations involving these devices. Lead extraction is mandated for infections, but vegetations may embolize, causing complications. Surgical debridement is recommended; alternatives include cardiopulmonary bypass, minimally invasive thoracotomy, or transatrial approaches. The AngioVac device allows percutaneous right heart bypass and suction removal of vegetations under echocardiographic and fluoroscopic guidance. This case series describes our first 20 patients, all critically ill with persistent sepsis and vegetations despite long-term antibiotics. This series includes patients who would not have been eligible for alternative procedures due to contraindications and highlights the potential role of this new technology.

Endovascular recanalization of a thrombosed native arteriovenous fistula complicated with an aneurysm: technical aspects and outcomes.

ObjectiveTo evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm.Materials and MethodsSixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis.ResultsThe thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively.ConclusionThrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.

Mechanical Thrombectomy with Trerotola Compared with Catheter-directed Thrombolysis for Treatment of Acute Iliofemoral Deep Vein Thrombosis

Mechanical thrombectomy (MT) of acute deep vein thrombosis (DVT) is safe and effective in reducing thrombus burden. MT utilizing a percutaneous thrombectomy device confers a great advantage because it may reduce both the dose of the thrombolytic agent and the overall procedure time compared with a conventional catheter-directed thrombolysis (CDT). We examined the results of MT using the Trerotola device and evaluated factors affecting patient outcome. This retrospective study was performed using data from a database of patients who had undergone treatment for an acute iliofemoral DVT from January 2005 to December 2011, at 2 institutions. The patients' clinical characteristics and procedures were compared, and the outcomes of treatment with the Trerotola in the MT group were compared with those obtained with CDT. There were a total of 98 DVTs (left 76; right 22) in 90 patients (34 men); 53 DVTs were treated with MT and 45 with CDT. There were no statistical differences in the clinical characteristics among the MT with CDT, MT only and CDT group. Inferior vena cava filters were placed in 93 DVTs (95%), and iliac vein stenting was used in 64 (65%). Symptom improvement was seen in 78% (18 limbs) of the MT group, 80% (24 limbs) of the MT with CDT group, and 71% (32 limbs) of the CDT group (P = 0.498). The procedure time was shorter in the MT with CDT group (18.2 ± 8.2 hr) or in the MT only group (2.7 ± 2.0 hr) compared with the CDT group (29.3 ± 9.4 hr; P < 0.001). Urokinase dose was lower in MT only (0 million units) or in the MT with CDT group (5.13 ± 3.72 million units) than in the CDT group (7.51 ± 4.54 million units; P < 0.001). There was no difference in complications during the procedures or in primary patency rate during the follow-up period (mean 16.0 ± 19.1 months; range: 0-78 months). MT with the Trerotola device for acute iliofemoral DVT required shorter procedure times and lower urokinase doses than conventional CDT, while providing the same results.

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

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.

Comparisons of clinical outcomes for thrombectomy devices with different mechanisms in hemodialysis arteriovenous fistulas

To compare clinical outcomes between mechanical thrombectomy devices with hydrodynamic mechanism and rotational mechanism. A number of advantages and concerns have been raised for different mechanical devices but the comparisons of clinical outcomes are absent, especially for the treatment of autogenous hemodialysis arteriovenous (AV) fistulas. The authors retrospectively reviewed 275 percutaneous thrombectomy procedures in AV fistulas. Procedures included were thrombectomy using devices with hydrodynamic mechanism, the AngioJet rheolytic catheter (AngioJet) (n = 134) or devices with rotational mechanism, the Arrow-Trerotola percutaneous thrombectomy device (PTD) (n = 141). Measured outcomes included clinical success, complications and patency rates. Clinical success was achieved in 76% (102 of 134) of the AngioJet procedures and in 91% (128 of 141) of the PTD procedures (P = 0.002). The procedure time for the PTD method was significantly shorter than that of the AngioJet method (52 vs. 88 min, P < 0.001). Complications occurred in 14% of the AngioJet procedures and 11% of the PTD procedures. The post-intervention primary patency rates at 6 months were 45% for the AngioJet group and 43% for the PTD group (P = 0.70). The postintervention secondary patency rates at 1 year were 74% for the AngioJet group and 87% for the PTD group (P = 0.01). For the salvage of thrombosed AV fistulas, a device using rotational mechanism is more time-saving with a higher immediate success rate and secondary patency rate. However, the long-term patency results were not different.

Retrospective Comparison of Mechanical Percutaneous Thrombectomy of Hemodialysis Arteriovenous Grafts With the Arrow-Trerotola Device and the Lyse and Wait Technique

The purpose of our study was to determine whether pharmacologic thrombolysis with urokinase in the lyse and wait (L&W) technique compared with mechanical declotting using the Arrow-Trerotola percutaneous thrombectomy device is more efficient, safer, or less expensive in treating thrombosed hemodialysis grafts. The files of 157 patients who underwent arteriovenous graft declotting from 2000 to 2007 at one tertiary care center were reviewed. The study group included 83 women and 74 men with a mean age of 68 +/- 12 years (range, 27-95 years). A total of 563 procedures were performed: 427 with the L&W technique and 136 with mechanical percutaneous thrombectomy using the percutaneous thrombectomy device. The two types of procedures were compared for success rate, complications, average patency time, and cost. There were no statistically significant differences between the pharmacologic and mechanical procedures in immediate success rate (99% and 98%, respectively) or average patency time (5.44 months and 5.40 months, respectively). The L&W technique was considerably less expensive. Given its lower cost and equal efficacy and safety, L&W appears to be preferable to mechanical thrombolysis with a percutaneous thrombectomy device for initial arteriovenous hemodialysis graft declotting.

AS-43: Comparison of Arrow-Trerotola Percutaneous Thrombectomy Device versus AngioJet Rheolytic Catheter in the Treatment of Thrombosed Native Hemodialysis Arteriovenous Fistulas

Percutaneous thrombectomy has become an accepted treatment for thrombosed hemodialysis native arteriovenous (AV) fistulas. Devices with different mechanisms have been developed for thrombus removal. The aim of our study was to compare the efficacy, safety, and patency between thrombectomy devices of different mechanisms for the treatment of thrombosed native AV fistulas.

Improving the Effectiveness of the Trerotola Percutaneous Thrombectomy Device in Thrombosed Dialysis Arteriovenous Fistulas

Improving the Effectiveness of the Trerotola Percutaneous Thrombectomy Device in Thrombosed Dialysis Arteriovenous Fistulas

Atherosclerotic Peripheral Vascular Disease Symposium II

Percutaneous intervention for peripheral artery disease has evolved from balloon angioplasty for simple focal lesions to multimodality techniques that enable treatment of severe arterial insufficiency. This technological expansion comes without a standard approach or algorithm, which makes the decision-making process more subjective than objective. Nevertheless, clinical tools are available that can have a favorable effect on patient care, and these promote usage. So, when are standard endovascular techniques (such as balloon and stents) good enough, and when are the latest advances (eg, atherectomy, drug-eluting stents) more appropriate? This section will address these questions for acute limb ischemia (ALI) and chronic critical limb ischemia (CLI). It will also delineate the problem of restenosis, particularly of the superficial femoral artery (SFA), and describe treatment alternatives. The discussion will review the role of drug-eluting stents, atherectomy devices, reentry catheters, and brachytherapy, as well as their potential complications and appropriate remedies. Treatment algorithms for aortoiliac and infrainguinal disease are provided in Figures 1 through 3⇓⇓. Figure 1. Treatment algorithm for acute lower-limb ischemia. *Short infusion of thrombolytic therapy proximal to occlusion can be used to facilitate wire traversal. Figure 2. Simplified treatment algorithm for symptomatic aortoiliac disease in patients deemed candidates for revascularization. In patients with multilevel disease, the aortoiliac segment should be addressed first. TASC indicates TransAtlantic Inter-Society Consensus; AI, aortoiliac; PTA, percutaneous transluminal angioplasty; PE, physical examination; ABI, ankle-brachial index; and U/S, ultrasound. Figure 3. Simplified treatment algorithm for symptomatic infrainguinal peripheral arterial disease, assuming concomitant aortoiliac disease has been treated and the patient is an acceptable candidate for revascularization. *Alternative therapies to PTA include cryotherapy, atherectomy (directional, rotational, ablative), and cutting balloon. †Alternative stent options include stent (graft, balloon expanding, and self expanding) and drug-eluting stent. PTA indicates percutaneous transluminal angioplasty; TASC, TransAtlantic Inter-Society Consensus; PE, physical examination; …