Prior Percutaneous Intervention Research Articles

Effectiveness of Pre-TAVR CTA as a Screening Tool for Significant CAD Before TAVR

BackgroundComputed tomography angiography (CTA) and invasive coronary angiography (ICA) are routinely performed before transcatheter aortic valve replacement (TAVR) to assess aortic root anatomy and screen for coronary artery disease (CAD), respectively. ObjectivesThis study explored the efficacy of CTA as a screening tool for significant proximal CAD before TAVR. MethodsWith proper ethical oversight, patients undergoing TAVR at Cleveland Clinic with a preprocedural CTA and invasive coronary angiography (ICA), and no prior percutaneous intervention, were identified from 2015 to 2021. Blinded to ICA results, the authors reviewed the left main, proximal left anterior descending coronary artery, proximal left circumflex coronary artery, and proximal right coronary artery by CTA coronary reconstruction to assess for nonsignificant stenosis (0% to 49%), moderate stenosis (50% to 69%), and severe stenosis (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen Kappa statistic were analyzed. Results2,217 patients (53.4% male, age 79.2 ± 8.5 years) met inclusion criteria. CTA evaluation revealed a sensitivity of 90%, specificity of 92%, PPV of 74%, and NPV of 97% for detecting ≥50% stenosis. Using a ≥70% stenosis cutoff, evaluation revealed a sensitivity of 91%, specificity of 97%, PPV of 83%, and NPV of 99%. Assessment of bypass graft patency revealed a sensitivity of 86%, specificity of 97%, PPV of 84%, and NPV of 98%. Cohen Kappa analysis indicated substantial to near perfect agreement between pre-TAVR CTA and ICA. ConclusionsPre-TAVR CTA has a high NPV for high-grade proximal stenosis of each coronary artery. As a result, CTA can be used as a screening tool to rule out significant proximal CAD in patients undergoing TAVR.

Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naïve patients is determined predominantly by operator, patient, and lesion characteristics

Intravascular Ultrasound (IVUS) has been shown to improve clinical outcomes in patients undergoing percutaneous intervention (PCI) in numerous trials. However, it is still underutilized outside of trial settings, and most trials include a significant proportion of patients with prior PCI. The aim of this study is to look at real-world use and outcomes in PCI-naïve patients who undergo IVUS-guided intervention. Prospectively collected data from 10,574 consecutive patients undergoing their index PCI was retrospectively analyzed. 455 (4.3%) patients underwent IVUS, with a median follow-up of 4.6 years. Patients undergoing IVUS had higher levels of comorbidities including diabetes (27.5% vs. 19.7%, p < 0.001), hypertension (58.0% vs. 47.9%, p < 0.001), hypercholesterolemia (51.6% vs. 39.2%, p < 0.001) and were generally older (65.9 ± 14.5 vs. 64.5 ± 13.4 years, p = 0.031) with higher mean baseline creatinine levels (95.4 ± 63.3 vs. 87.8 ± 46.1 μmol/L). The strongest predictor of IVUS use was the operating consultant graduating from medical school after the year 2000 [OR 14.5 (3.5-59.8), p < 0.001] and the presence of calcific lesions [OR 5.2 (3.4-8.0) p < 0.001]. There was no significant difference in MACE nor 1-year mortality between patients undergoing IVUS-guided or angiography-only PCI on unadjusted analysis [OR 1.04 (0.73-1.5), p = 0.81, OR 1.055 (0.65-1.71) p = 0.828] nor mortality throughout the study period (HR 0.93 (0.69-1.26), p = 0.638). This held true for stents longer than 28 mm. Propensity matched analysis of patients similarly showed no mortality difference between arms for all patients and those with longer stents (p = 0.564 and p = 0.919). The strongest predictors of IVUS use in PCI-naïve patients are the operator's year of graduation from medical school and proxy measures of calcific lesions. On both matched and adjusted analysis there was no evidence of improved mortality nor reduced MACE in this specific retrospective cohort, although this may well be explained by significant selection bias.

P.0817 Sociodemographic and lifestyle predictors of mental health adaptability during COVID-19 compulsory confinement: a longitudinal study

There is conflicting evidence for adverse outcomes after coronary artery bypass surgery (CABG) with prior percutaneous intervention (PCI). A literature search was performed from 1998 to 2017 and articles with primary or secondary outcomes of survival, major adverse cardiovascular events (MACE), and myocardial infarction in CABG patients with prior PCI were included. Forest plots were generated from odds ratios for survival, MACE, and myocardial infarction for unmatched and propensity-matched data. Heterogeneity between studies was assessed for all outcomes using I2. Funnel plots were generated for early survival, survival at 5 years, survival at >5 years, and MACE. Thirty-one studies were included over 18 years with 194,544 patients without PCI prior to CABG and 23,519 patients (12.09%) with prior PCI. Prior PCI did not adversely affect survival among the included studies (inverse rate ratio: 1.12, 95% confidence interval: 0.98–1.27, P = 0.110. MACE was significantly worse for those with prior PCI (odds ratio: 1.26, confidence interval: 1.02–1.55, P = 0.03). The relative risk of mortality associated with prior PCI has decreased significantly over the last 2 decades. Studies with higher percentage of prior PCI patients had higher relative mortalities. There was significant heterogeneity between studies for the treatment effects. PCI prior to CABG in recent times does not adversely affect survival despite adverse early and late MACE rates. However, high institutional rates of prior PCI may be associated with increasing mortality after CABG.

Prevalence and Management of Coronary Artery Disease in Patients With Asymptomatic Bilateral Carotid Stenosis

The prevalence of coronary artery disease (CAD) in asymptomatic patients with bilateral carotid stenosis >70%, and its clinical impact is unclear. The aim was to describe CAD prevalence, management, and clinical impact in patients with bilateral carotid stenosis. We conducted a single-center retrospective review of patients referred for bilateral carotid stenosis >70%. All patients underwent systematic coronary angiography. Depending on anatomic and clinical characteristics, patients were addressed to combined carotid endarterectomy (CEA) + coronary artery bypass grafting (CABG), coronary percutaneous intervention (PCI) followed by CEA or stenting (CAS), or staged bilateral CEA/CAS under cardiac best medical therapy (Fig). The cumulative stroke + myocardial infarction (MI) rate after cardiac and bilateral carotid interventions was assessed, as well as long-term survival and freedom from cardiovascular mortality. Multiple logistic regression was performed to identify factors associated with CAD and cumulative stroke + MI. Kaplan-Meier estimates were used to describe time-dependent outcomes. There were 166 patients with bilateral carotid stenosis >70%. Preoperative coronary angiography identified a significant CAD in 108 cases (65.1%) with single-vessel (n = 39; 36.1%), two-vessel (n = 30; 27.8%), three-vessel (n = 20; 18.5%), or left main disease (n = 19; 17.6%). After multiple logistic regression, prior CABG (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.01-7.89; P = .04), prior PCI (OR, 3.12; 95% CI, 1.74-10.91; P < .01), and dyslipidemia (OR, 3.55; 95% CI, 1.13-14.44; P = .04) were significantly associated with critical CAD. CAD was treatable in 91 patients (84%) and untreatable in 17 (16%). Sixty-three (58%) patients received a prophylactic PCI followed by staged bilateral CEA, 28 (26%) underwent concomitant CEA + CABG followed by contralateral CEA. Patients with untreatable CAD received bilateral CAS (n = 10; 59%) or CEA (n = 7; 41%) under best medical therapy. Fifty-eight patients without critical CAD underwent staged bilateral CEA. The cumulative MI and stroke rates were 6.2% and 2.1% respectively. The stroke + MI rate was similar in case of treatable CAD compared with patients without CAD (OR, 0.31; 95% CI, 0.14-2.42; P = .53). At the multivariate analysis, patients with an untreatable CAD were at higher risk of stroke + MI (OR, 1.24; 95% CI, 1.00-2.83; P = .04). At 5 years, overall survival was 80.4% (95% CI, 69%-93%), and freedom from cardiovascular mortality was 95.3% (95% CI, 88%-100%). Patients with preoperative untreatable CAD maintained a higher risk of 5-year mortality (hazard ratio, 5.5; 95% CI, 1.6-19.9; P < .01). The prevalence of CAD in patients with bilateral carotid stenosis is high. Prophylactic PCI or concomitant CEA + CABG allowed similar results compared with those without critical CAD. Patients with critical CAD unsuitable for PCI or CABG were at higher risk of stoke + MI and long-term mortality.

Prior Percutaneous Coronary Interventions May Be Associated With Increased Mortality After Coronary Bypass Grafting: A Meta-Analysis

There is conflicting evidence for adverse outcomes after coronary artery bypass surgery (CABG) with prior percutaneous intervention (PCI). A literature search was performed from 1998 to 2017 and articles with primary or secondary outcomes of survival, major adverse cardiovascular events (MACE), and myocardial infarction in CABG patients with prior PCI were included. Forest plots were generated from odds ratios for survival, MACE, and myocardial infarction for unmatched and propensity-matched data. Heterogeneity between studies was assessed for all outcomes using I2. Funnel plots were generated for early survival, survival at 5 years, survival at >5 years, and MACE. Thirty-one studies were included over 18 years with 194,544 patients without PCI prior to CABG and 23,519 patients (12.09%) with prior PCI. Prior PCI did not adversely affect survival among the included studies (inverse rate ratio: 1.12, 95% confidence interval: 0.98-1.27, P = 0.110. MACE was significantly worse for those with prior PCI (odds ratio: 1.26, confidence interval: 1.02-1.55, P = 0.03). The relative risk of mortality associated with prior PCI has decreased significantly over the last 2 decades. Studies with higher percentage of prior PCI patients had higher relative mortalities. There was significant heterogeneity between studies for the treatment effects. PCI prior to CABG in recent times does not adversely affect survival despite adverse early and late MACE rates. However, high institutional rates of prior PCI may be associated with increasing mortality after CABG.

Clinical Profile of Patients With Chronically Occluded Coronary Arteries: A Single Center Study.

BackgroundA chronic total occlusion (CTO) is defined as an angiographically documented or clinically suspected complete interruption of antegrade coronary flow (Thrombolysis in Myocardial Infarction (TIMI)-0 flow) of greater than 3 months standing. Coronary CTOs represent the most technically challenging lesion subset that interventional cardiologists face. CTOs are identified in up to one third of patients referred for coronary angiography and remain seriously undertreated with percutaneous techniques. Decision to treat or not to treat a CTO is always confusing. This is an attempt to provide clinical profile of patients having totally occluded coronary arteries and their natural history.MethodsThe observational study was carried out in tertiary health center in Mumbai. Totally 117 patients who had CTO on angiography were selected. Their clinical presentation and angiography correlation was done and results were analyzed.ResultsOut of a total of 117 patients, 86 (73.50 %) were males, female 31(26%). All of the patients studied were above 40 years. Age group 40 - 49 years had 25 (21.36%) patients, 50 - 59 years had 32 (27.35%), 60 - 69 years had 43 (36.75%), > 70 years had 17 (14.52%) patients. Smoking as a risk factor was present in 32 (27.35%), tobacco in 45 (38.46%), alcohol in six (5%), no addictions in 35 (29.91%) patients. Diabetes in 63 (53.84%), hypertension in 78 (66.67%) patients, both were present in 49 (41.88%), dyslipidemia in 37 (31.62%) patients. Sixty-three (53.84 %) patients presented with unstable angina (UA)/non ST elevated myocardial infarction (NSTEMI), 32 (27.35%) with chronic stable angina (CSA), ST elevated myocardial infarction (STEMI) in 22 (18.80%). History of prior myocardial infarction (MI) was present in 36 (30.76%), prior coronary artery bypass graft (CABG) in nine (7.6%), prior percutaneous intervention (PCI) in 18 (15.38%). Triple vessel disease (TVD) in 38 (32.47%), double vessel disease (DVD) in 53 (45.29%), single vessel disease (SVD) in 26 (22.22%) patients. Left anterior descending artery (LAD) CTO was present in 40 (34.18%), right coronary artery (RCA) in 61 (52.14%), left circumflex artery (LCX) obtuse marginal (OM) in 16 (13.67%) patients.ConclusionsPatients having CTO of coronary arteries are mostly above age of 40 years. Most common age group was 60 - 69 years. It was most common in males than females. Tobacco chewing was more commonly associated followed by smoking. Hypertension and diabetes were strongly associated with CTO. Most patients presented with unstable angina/NSTEMI followed by chronic stable angina. Old MI was present in one third of patients. Most common artery to be affected was RCA followed by LAD.

Outcomes of open and endovascular lower extremity revascularization in active smokers with advanced peripheral arterial disease

ObjectiveConcern over perioperative and long-term durability of lower extremity revascularizations among active smokers is a frequent deterrent for vascular surgeons to perform elective lower extremity revascularization. In this study, we examined perioperative outcomes of lower extremity endovascular (LEE) revascularization and open lower extremity bypass (LEB) in active smokers with intermittent claudication (IC) and critical limb ischemia (CLI). MethodsActive smokers undergoing LEE or LEB from 2011 to 2014 were identified in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) targeted vascular data set. Patient demographics, comorbidities, anatomic features, and perioperative outcomes were compared between LEE and LEB procedures. Subgroup analysis was performed for patients undergoing revascularization for IC and CLI independently. ResultsFrom 2011 to 2014, 4706 lower extremity revascularizations were performed in active smokers (37% of all revascularizations). In this group, 1497 were LEE (55.6% for CLI, 13.4% for below-knee pathology) and 3209 were LEB (68.9% CLI, 34.7% below-knee). Patients undergoing LEE had higher rates of female gender, hypertension, end-stage renal disease, and diabetes (all P ≤ .02). LEE patients also had a higher frequency of prior percutaneous interventions (22.7% vs 17.2%; P < .01) and preoperative antiplatelet therapy (82.3% vs 78.7%; P = .02). On risk-adjusted multivariate analysis, LEE patients had higher need for reintervention on the treated arterial segment than LEB (5.1% vs 5.2%; odds ratio [OR], 1.52; 95% confidence interval [CI], 1.08-2.13; P = .02) but had lower wound complications (3.1% vs 13.2%; OR, 0.32; 95% CI, 0.23-0.45; P < .01) and no statistically significant difference in 30-day mortality (0.6% vs 0.9%), myocardial infarction or stroke (1.1% vs 2.6%), or major amputation (3.2% vs 2.1%) in the overall cohort of active smokers. In the IC subgroup, myocardial infarction or stroke was significantly higher in the LEB group (1.9% vs 0.6%; OR, 1.83; 95% CI, 1.17-1.97; P = .03), although no difference was found in the CLI subgroup (2.8% vs 1.4%; OR, 0.75; 95% CI, 0.37-1.52; P = .42,). Also in IC group, there was a trend for lower major amputation rates ≤30 days in the LEE group, whereas in the CLI group, LEE had a trend toward higher risk of early amputation compared with LEB. ConclusionsIn active smokers, LEB for IC and CLI requires fewer reinterventions but is associated with a higher rate of postoperative wound complications compared with LEE revascularization. However, the risk for limb amputation is higher in actively smoking patients when treated by LEE compared with LEB for CLI. Importantly, cardiovascular complications are significantly higher in actively smoking patients with IC undergoing LEB compared with LEE. This additional cardiovascular risk should be carefully weighed when proposing LEB for actively smoking patients with nonlimb-threatening IC.

Amniotic Band Syndrome: A Single-Institutional Experience

Introduction: Amniotic band syndrome (ABS) is uncommon. We review our single-institutional experience to define its natural history and outcomes. Materials andMethods: We conducted a retrospective analysis from a single, tertiary referral center of patients evaluated for and confirmed to have ABS from 1997 to 2012. Results: Twenty-eight patients had confirmed ABS. The mean ± SD maternal age was 27.9 ± 5.9 years, and the mean gestational age at diagnosis was 20.7 ± 3.8 months. Oligohydramnios was reported in 4 patients. Eleven patients had membrane disruption, of whom 4 had undergone a prior percutaneous intervention. Extremities were the most common site affected (n = 20), followed by the umbilical cord (n = 7), abdomen (n = 5), limb-body wall complex (n = 5), head (n = 1), and chest (n = 1). Nine patients were felt to be candidates for fetal intervention; 5 underwent fetoscopic amniotic band lysis with 4 survivors. Overall survival, excluding 3 terminations, was 74%. There were 5 fetal demises and one neonatal death. Cord involvement was higher in nonsurvivors (67%) compared to survivors (19%, p = 0.05). Discussion: ABS most commonly involves the extremities. Membrane disruption is not always present. Fetoscopic lysis is appropriate for select patients, and special consideration should be given for cord involvement, which is associated with a worse outcome.

Transradial Versus Transfemoral Method of Two‐Stent Implantation for True Bifurcation Lesions: Comparison of Immediate and Long‐Term Outcomes

The feasibility, safety, and efficacy of two-stent implantation for true bifurcation disease through transradial (TR) versus transfemoral (TF) approaches have not been thoroughly investigated. We compared procedural and long-term outcomes of a two-stent strategy percutaneous revascularization in 805 consecutive patients with true bifurcation lesions requiring two-stent implantation via either a TR (n = 508) or TF (n = 297) approach from 2004 to 2009. Clinical and angiographic characteristics, procedural outcomes, and in-hospital and long-term clinical events were compared according to vascular access strategy. Using logistic regression to derive a propensity score model, 249 matched patient pairs were compared. The demographic, angiographic, and procedural characteristics were similar between groups, with the exception of less prior percutaneous intervention and left main bifurcation or multivessel disease in the TR group (all P < 0.05). Angiographic success and fluoroscopy time were similar between cohorts. The duration of hospitalization and in-hospital occurrence of Bleeding Academic Research Consortium defined bleeding (3.9% vs. 9.1%, P < 0.01) were significantly lower in the TR group. During a mean follow-up period of 55 ± 22 months, in a multivariate regression analysis, the TR method was not predictive of major adverse cardiac events (adjusted hazards ratio [HR]: 1.33, 95% confidence interval [CI]: 0.83-2.14), cardiac death, myocardial infarction, target vessel revascularization (HR: 0.93, 95% CI: 0.45-1.93), or stent thrombosis. In comparison to TF vascular access, two-stent implantation via TR approach for true bifurcation lesions is associated with similar in-hospital outcomes, shorter hospitalization, reduced bleeding, and comparable long-term clinical safety and efficacy.

Surgical Repair of Ventricular Septal Defect After Myocardial Infarction: Outcomes From The Society of Thoracic Surgeons National Database

The development of a ventricular septal defect (VSD) after myocardial infarction (MI) is an uncommon but highly lethal complication. We examined The Society of Thoracic Surgeons database to characterize patients undergoing surgical repair of post-MI VSD and to identify risk factors for poor outcomes. This was a retrospective review of The Society of Thoracic Surgeons database to identify adults (aged≥18 years) who underwent post-MI VSD repair between 1999 and 2010. Patients with congenital heart disease were excluded. The primary outcome was operative death. The covariates in the current The Society of Thoracic Surgeons model for predicted coronary artery bypass grafting operative death were incorporated in a logistic regression model in this cohort. The study included 2,876 patients (1,624 men [56.5%]), who were a mean age of 68±11 years. Of these, 215 (7.5%) had prior coronary artery bypass grafting operations, 950 (33%) had prior percutaneous intervention, and 1,869 (65.0%) were supported preoperatively with an intraaortic balloon pump. Surgical status was urgent in 1,007 (35.0%) and emergencies in 1,430 (49.7%). Concomitant coronary artery bypass grafting was performed in 1,837 (63.9%). Operative mortality was 54.1% (1,077 of 1,990) if repair was within 7 days from MI and 18.4% (158 of 856) if more than 7 days from MI. Multivariable analysis identified several factors associated with increased odds of operative death. In the largest study to date to examine post-MI VSD repair, ventricular septal rupture remains a devastating complication. As alternative therapies emerge to treat this condition, these results will serve as a benchmark for future comparisons.

Diffuse coronary artery disease requires long coronary arteriotomy reconstruction as an adjunct to bypass grafting

Objectives: Myocardial revascularization procedures are increasingly used for end-stage, diffuse coronary disease with multiple prior percutaneous interventions. We present our surgical strategies to manage those heavily calcified target vessels that are technically most challenging.

E0354 Angiographic characteristics of premature coronary heart disease—analyses of single center

BackgroundThere are no large-sample published reports prospectively or consecutively assessing the angiographic characteristics of premature coronary heart disease in China.ObjectivesThe present study was carried out to collect and analyse the...

Coronary bypass surgery in patients treated with clopidogrel. Is it safe?

Current guidelines for the management of acute coronary syndrome clearly recommend that clopidogrel should be started before diagnostic coronary angiography. If patients undergo coronary artery bypass grafting (CABG) early after clopidogrel loading or during continued exposure, it seems reasonable to expect an increase in bleeding complications. Earlier studies may have overestimated the risk of bleeding in patient undergoing CABG with prior clopidogrel exposure (5-10-fold increase). Some conflicting results are reported in literature. As reexploration because of excessive bleeding is concerned, a two to three-fold increase must be expected, which is demonstrated in actual trials properly matched to confounding factors. Discontinuation of clopidogrel for 5-7 days prior to urgent CABG as recommended by guidelines is not well adopted in clinical practice for several reasons. There is a moderately elevated risk of bleeding complications after CABG due to prior clopidogrel exposure alone. However, in clinical practice this risk is added often to patients who carry already elevated surgical risks (urgent procedures, worse coronary anatomy, history of previous myocardial infarction and prior percutaneous intervention), and after bleeding complications singular patients may suffer from consecutive adverse outcome. Cessation of clopidogrel in patients before CABG clearly prolongs hospitalization time and has an estimated 1% risk of coronary events during the waiting period. Risk and benefit have to be balanced in every individual case.

The effect of previous coronary artery stenting on short- and intermediate-term outcome after surgical revascularization in patients with diabetes mellitus

Percutaneous intervention for coronary revascularization is associated with an increased risk of repeat revascularization, especially in patients with diabetes mellitus. In this study we sought to examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome and intermediate-term survival in patients undergoing coronary artery bypass surgery. Between January 1, 2001, and December 31, 2006, 1758 consecutive patients with diabetes mellitus who underwent first-time isolated coronary artery bypass surgery were identified. Survival and major perioperative complications for 1537 patients who did not have prior percutaneous intervention (group 1) were compared with those in 221 patients with prior percutaneous intervention (group 2) after adjusting for baseline risk factors. Vital status was determined by using the National Death Index and Social Security Death Index. Age-adjusted survival at 2 years' follow-up was calculated with the Cox singular proportional hazards model. At baseline, group 2 patients had higher incidences of hypercholesterolemia and myocardial infarction. Compared with group 1 patient, group 2 patients had significantly higher operative mortality (adjusted odds ratio, 4.05; 95% confidence interval, 1.41-11.63), perioperative major adverse cardiac events (adjusted odds ratio, 2.72; 95% confidence interval, 1.08-6.85), and atrial fibrillation (adjusted odds ratio, 1.97; 95% confidence interval, 1.29-3.01). Group 2 patients had worse age-adjusted survival at 2 years' follow-up (93.4% vs 87.4%, P < .017). Patients with diabetes mellitus and a history of percutaneous coronary stenting before coronary artery bypass surgery were found to have an increased risk of operative death, increased perioperative complications, and decreased age-adjusted survival at 2 years' follow-up.

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

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.