Rationale and objectives: To evaluate the feasibility of mechanical thrombectomy in occluded hemodialysis access shunts by using a newly developed 5F pigtail rotation catheter.
Methods: Thrombosed hemodialysis access shunts were simulated by clotted bovine blood in silicone tubing (diameter 6 mm). After retrograde and antegrade sheath placement (6F), mechanical fragmentation was performed using a 5F rotatable pigtail device. Average tube length was 27 to 47 cm; average thrombus weight was 5 to 11.9 g (8.2 +/- 1.59). Clinical application involved six patients with fresh shunt occlusions (three Brescia-Cimino shunts, three Gore-Tex shunts).
Results: Using the in vitro setup, the device was able to restore a continuous lumen within 10 minutes with no remaining wall-adherent thrombi. The average amount of particles in the effluent was 3.0 g (2.0 to 3.9) for particles < or = 1.0 mm and 0.67 g (0.44 to 0.96) for particles > or = 0.2 mm wet weight; (compared with initial thrombus weight, 30.7% and 1.1%, respectively). Clinically, all six hemodialysis access shunts were successfully recanalized. Technical problems did not occur. There were no clinical symptoms indicating pulmonary embolism in any of the treated patients.
Conclusions: In our experimental setup as well as under clinical conditions, effective treatment of occluded hemodialysis access sites was achieved. The pigtail rotation device is an easy-to-handle, inexpensive alternative to mechanical thrombus fragmentation in occluded hemodialysis access shunts. The rate of emboli in the effluent vein of approximately one third of the initial thrombus weight must be taken into consideration in frequent intraindividual use of this technique.