Document Detail


A novel fluoroscopic-assisted balloon thrombectomy technique for thrombosed hemodialysis prosthetic grafts [corrected].
MedLine Citation:
PMID:  20119918     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Previous studies have shown that stenosis of the arterial anastomosis of thrombosed hemodialysis (HD) grafts, unmasked after conventional thrombectomy, very often necessitate subsequent arterial angioplasty. The aim of this study was to describe a novel fluoroscopic-assisted balloon thrombectomy technique which permits simultaneous arterial angioplasty (should this is required) for thrombosed HD grafts.
METHODS: Thirty patients with 36 thrombotic episodes of their prosthetic HD grafts participated in this study. A balloon angioplasty catheter is placed beyond the arterial anastomosis, over a guidewire; the balloon is inflated with contrast solution under fluoroscopy and pulled back to remove the arterial thrombus from the anastomosis. Any coexisting stenosis revealed by balloon indentation is completely dilated at that time, rather than after the thrombectomy. Mechanical thrombolysis of the graft and venous outflow is then performed with the AngioJet catheter (Possis Medical, Inc).
RESULTS: Technical and clinical success rates (the latter defined as one subsequent HD session) of the procedure were 100% and 94%, respectively. No complications, including arterial embolism, vessel rupture or pulmonary embolism, were encountered. Primary assisted patency at 3 and 6 months was 51% and 32%, respectively, while functional secondary patency at the same follow-up points was 78%.
CONCLUSIONS: Our technique is safe and also effective in both short- and long-term follow-up. Because it offers convenience, since the treatment of arterial anastomotic stenoses is accomplished in one (rather than two) steps, this method deserves further investigation.
Authors:
Stavros K Kakkos; Joseph A Haddad; Georges K Haddad
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of vascular access     Volume:  11     ISSN:  1129-7298     ISO Abbreviation:  J Vasc Access     Publication Date:    2010 Jan-Mar
Date Detail:
Created Date:  2010-04-12     Completed Date:  2010-07-06     Revised Date:  2011-02-10    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  8-11     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon* / adverse effects
Arteriovenous Shunt, Surgical / adverse effects,  instrumentation*
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects,  instrumentation*
Constriction, Pathologic
Female
Fluoroscopy
Graft Occlusion, Vascular / etiology,  physiopathology,  radiography,  therapy*
Humans
Male
Middle Aged
Prosthesis Failure
Radiography, Interventional*
Renal Dialysis*
Thrombectomy* / adverse effects
Thrombolytic Therapy
Thrombosis / etiology,  physiopathology,  radiography,  therapy*
Time Factors
Treatment Outcome
Upper Extremity / blood supply*
Vascular Patency
Comments/Corrections
Erratum In:
J Vasc Access. 2010 Apr-Jun;11(2):179

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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