Comparing Patency Rates of Arteriovenous Dialysis Access Following Percutaneous Thrombectomy Using Various Catheter Directed Therapies
Adam Hicks, Anthony Grzeda, Jessica Schucht, Charles Bush, Abindra Sigdel, Amit Dwivedi
University of Louisville, Louisville, KY
INTRODUCTION: Arteriovenous fistulas and grafts often require frequent interventions to maintain patency for hemodialysis. Interventions may include open or percutaneous thrombectomy with additional targeted interventions as clinically indicated. We evaluated the primary and secondary patency rates following three unique approaches to percutaneous thrombectomy.
METHODS:A retrospective review of 236 unique patients who presented with thrombosed hemodialysis access was reviewed over a period of 2 years from 2017-2019. We analyzed a total of 443 procedures that utilized three separate percutaneous thrombectomy devices to assist with restoring patency. The CAT-D Suction Thrombectomy Device (Penumbra; Alameda, CA), the Arrow-Trerotola Rotational Thrombectomy System (Teleflex; Wayne, PA) and the Angiojet Rheolytic Thrombectomy Catheter (Boston Scientific, Marlborough, MA) devices were compared for primary and secondary patency. Primary Patency was defined as time from percutaneous thrombectomy to next intervention (Angioplasty, stenting, repeat thrombectomy). Secondary patency was defined as time from percutaneous thrombectomy to time of access abandonment. Medical record chart review was utilized to determine patency rates.
RESULTS: A total of 443 patients underwent percutaneous thrombectomy. 98 patients underwent thrombectomy using Angiojet, 103 using Trerotola, and 200 using Penumbra. Mean Primary patency rates in (days) for the devices was as follows: Angiojet (194), Trerotola (204), and Penumbra (107). Angiojet vs Penumbra and Trerotola vs Penumbra both showed diminished patency rates when using the Penumbra Catheter that were statistically significant (P<.001)
CONCLUSIONS:In conclusion, all percutaneous thrombectomy approaches do not result in the same primary or secondary patency rates. Approaches with Trerotola and Angiojet resulted in improved primary and secondary patency rates while those using Penumbra for thrombectomy resulted in shorter primary and secondary patency rates.
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