Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter

PURPOSE: To evaluate mechanical thrombectomy of occluded hemodialysis access shunts with a recently developed hydrodynamic device. MATERIALS AND METHODS: 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). RESULTS: 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. CONCLUSION: Effectiveness of mechanical thrombectomy of occluded hemodialysis access shunts with the described hydrodynamic device is similar to that of alternative treatments such as thrombolysis.