Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter.

Abstract

To evaluate mechanical thrombectomy of occluded hemodialysis access shunts with a recently developed hydrodynamic device. Sixty-five thrombosed hemodialysis access shunts were treated in 49 patients. The shunts were of three types: Brescia-Cimino fistulas (24 procedures), polytetrafluoroethylene (PTFE; Gore-Tex) loop grafts (18 procedures), and manufactured homologous vein loop grafts (23 procedures). Clots were removed by means of aspiration caused by the hydrodynamic effect of a high-velocity flow of saline through the catheter (Venturi effect). Successful declotting was achieved in 58 of 65 (89%) attempts. Early reocclusion occurred in 11 shunts and was successfully treated by means of repeat thrombectomy in five instances. Procedure time averaged 1-1 1/2 hours. The primary patency was similar for the three types of access shunts (P = .09), with a median of 14 weeks (including the initial treatment failures). Assisted patency for polytetrafluoroethylene loop grafts was better than that for the two other types (P = .002). Complications were encountered in 10 of 65 (15%) cases. These included formation of a large local hematoma that resulted in loss of a Brescia-Cimino fistula, two instances of arterial embolization, and one case of pulmonary embolization of thrombus material. Effectiveness of mechanical thrombectomy of occluded hemodialysis access shunts with the described hydrodynamic device is similar to that of alternative treatments such as thrombolysis.